Relationship between Fib-4 score and nutritional status in patients with pulmonary hypertension

Abstract

Objective: Nutritional status has been associated with poor prognosis in many cardiovascular diseases. Recently, the Fib-4 index, which is a marker of liver cirrhosis risk, has also been investigated in cardiovascular diseases, and its association with poor prognosis has been shown. The goal of this study was to examine the connection between pulmonary hypertension patients' Fib-4 scores and nutritional status. Methods: 216 individuals who received a pulmonary hypertension diagnosis at our hospital between January 1, 2023, and December 31, 2023, were included in the research. The patients were divided into two groups based on their nutritional status: those who were malnourished (51) and those who were not (162). Results: Laboratory findings indicated that malnourished patients had significantly lower hemoglobin levels (12.3 ± 2.3 vs. 13.5 ± 2, p=0.002), platelet counts (228 ± 88 vs. 267 ± 123, p=0.044), and albumin levels (3.1 ± 0.4 vs. 4.1 ± 0.4, p<0.001) compared to non-malnourished patients. There was a strong correlation between the FIB-4 index and measures of nutritional status and inflammation. Conclusions: Malnourished individuals with PAH had greater comorbidity burdens and higher liver fibrosis indices. According to our study's findings, individuals with pulmonary hypertension may benefit from nutritional and liver health evaluations as part of their care to enhance their quality of life and clinical results.

Keywords

• Pulmonary hypertension
• Fib-4 index
• Controlling nutritional status
• Prognostic nutritional index

References

1. 1.Simonneau G, Montani D, Celermajer DS, et al.Haemodynamic definitions and updated clinicalclassification of pulmonary hypertension. EurRespir J. 2019;53(1).
2. 2.Kamran U, Towey J, Khanna A, et al. Nutrition inalcohol-related liver disease: Physiopathology andmanagement. World J Gastroenterol. 2020;26(22):2916-30.
3. 3.Pulley J, Todd A, Flatley C, Begun J. Malnutritionand quality of life among adult inflammatory boweldisease patients. JGH Open. 2020;4(3):454-60.
4. 4.Kawamoto A, Kato T, Minamino-Muta E, et al.Relationships between nutritional status andmarkers of congestion in patients with pulmonaryarterial hypertension. Int J Cardiol. 2015;187:27-8.
5. 5.Mat Nasir N, Md Isa Z, Ismail NH, et al. A cross-sectional analysis of the PURE study on mineralsintake among Malaysian adult population withhypertension. Sci Rep. 2024 Apr 13;14(1):8590.
6. 6.Kwant CT, de Man F, van der Horst FAL, BogaardHJ, Vonk Noordegraaf A. The UPHILL study: Anutrition and lifestyle intervention to improvequality of life for patients with pulmonary arterialhypertension. Pulm Circ. 2023 May27;13(2):e12243.
7. 7.Luo D, Xie N, Yang Z, Zhang C. Association ofnutritional status and mortality risk in patients withprimary pulmonary hypertension. Pulm Circ.2022;12(1):e12018.
8. 8.Zhang S, Li S, Gao L, et al. Effects of malnutritionon disease severity and adverse outcomes inidiopathic pulmonary arterial hypertension: aretrospective cohort study. Respir Res.2024;25(1):292.

9. 9. Jin JL, Zhang HW, Cao YX, et al. Liver fibrosis scores and coronary atherosclerosis: novel findings inpatients with stable coronary artery disease.Hepatol Int. 2021;15(2):413-23.
10. 10.Vieira Barbosa J, Milligan S, Frick A, et al.Fibrosis-4 Index Can Independently Predict MajorAdverse Cardiovascular Events in NonalcoholicFatty Liver Disease. Am J Gastroenterol.2022;117(3):453-61.
11. 11.Yokokawa T, Sugimoto K, Yoshihisa A, et al. TheFibrosis-4 Index Is Useful for Predicting Mortality inPatients with Pulmonary Hypertension due to LeftHeart Disease. Int Heart J. 2019;60(5):1147-53.
12. 12.Hendriks PM, Staal DP, van de Groep LD, et al.The evolution of survival of pulmonary arterialhypertension over 15 years. Pulm Circ. 2022 Oct1;12(4):e12137.
13. 13.Ignacio de Ulíbarri J, González-Madroño A, deVillar NG, et al. CONUT: a tool for controllingnutritional status. First validation in a hospitalpopulation. Nutr Hosp. 2005;20(1):38-45.
14. 14.Onodera T, Goseki N, Kosaki G. [Prognosticnutritional index in gastrointestinal surgery ofmalnourished cancer patients]. Nihon Geka GakkaiZasshi. 1984;85(9):1001-5.
15. 15.Wu PJ, Feng IC, Lai CC, et al. The mortality ofhospitalized patients with COVID-19 and non-cirrhotic chronic liver disease: a retrospective multi-center study. PeerJ. 2023 Dec 4;11:e16582. doi:10.7717/peerj.16582. PMID: 38077441; PMCID:PMC10702333.
16. 16.Møller S, Bernardi M. Interactions of the heartand the liver. Eur Heart J. 2013;34(36):2804-11.
17. 17.Samsky MD, Patel CB, DeWald TA, et al.Cardiohepatic interactions in heart failure: anoverview and clinical implications. J Am Coll Cardiol. 2013;61(24):2397-405.
18. 18.Yoshihisa A, Sato Y, Yokokawa T, et al. Liverfibrosis score predicts mortality in heart failurepatients with preserved ejection fraction. ESC HeartFail. 2018;5(2):262-70.
19. 19.Gelow JM, Desai AS, Hochberg CP, et al. Clinicalpredictors of hepatic fibrosis in chronic advancedheart failure. Circ Heart Fail. 2010;3(1):59-64.
20. 20.Sharma V, Patial V. Insights into the molecularmechanisms of malnutrition-associatedsteatohepatitis: A review. Liver Int. 2024Sep;44(9):2156-2173. doi: 10.1111/liv.15932. Epub2024 May 22. PMID: 38775001.
21. 21.Li N, Xu JH, Yu M, et al. Relationship betweenvirological response and FIB-4 index in chronichepatitis B patients with entecavir therapy. World JGastroenterol 2015; 21(43): 12421-9
22. 22.Pasini E, Aquilani R, Gheorghiade M, DioguardiFS. Malnutrition, muscle wasting and cachexia inchronic heart failure: the nutritional approach. ItalHeart J. 2003;4(4):232-5.