Non-invasive Liver Scores Can Predict Early Mortality after Left Ventricular Assist Device Implantation

Background: Left ventricular assist device (LVAD) implantation is the therapy of choice for end-stage heart failure patients who are not suitable for heart transplantation. However, optimal patient selection for LVAD therapy is crucial for long-term success and remains a challenge. Calculation of non-invasive liver fibrosis scores have recently gained interest in cardiovascular medicine as potentially predicting morbidity and mortality.

Methods: Between August 2008 and July 2024, a total of n = 368 consecutive patients underwent LVAD implantation in our department. Different non-invasive liver fibrosis scores including Fibrosis-4 (FIB-4), Model of End Stage Liver Disease (MELD), Non-Alcoholic Fatty Liver Disease (NAFLD), BMI-AST/ALT-Ratio-Diabetes (BARD), HUI, and Forns index were calculated from preoperative laboratory values. All scores were calculated with regular routine laboratory values such as liver enzymes and platelets. The aim of the study was to correlate liver fibrosis scores with the 30-day mortality after LVAD implantation.

Results: FIB-4 was available for n = 340 patients, MELD for n = 187, NALFD for n = 186, BARD for n = 195, HUI for n = 148, and Forns for n = 126 patients. Binary logistic regression revealed that FIB-4 was an independent risk factor for 30-day mortality with an odds ratio (OR) =1.2 (CI = 1.07–1.16, p < 0.01) as well as MELD (OR = 1.12, CI = 1.11–1.27, p < 0.01), NALFD (OR = 1.24, CI = 1.06–1.45, p = 0.01), HUI (OR = 29.65, CI = 3.54–248.43, p < 0.01), and Forns (OR = 1.47, CI = 1.27–1.79, p < 0.01) but not BARD (p = 0.30). The receiver operating characteristic (ROC) analysis showed that HUI performed the best of all scores, with an area under the curve (AUC) of 0.798 (CI = 0.71–0.88, p < 0.01) followed by FIB-4 of (AUC = 0.792, CI = 0.73–0.85, p < 0.01), MELD (AUC = 0.767, CI = 0.67–0.87, p < 0.01), Forns (AUC = 0.727, CI = 0.63–0.83, p < 0.01), and NALFD (AUC = 0.702, CI = 0.60–0.80, p < 0.01). Combining HUI and FIB-4 was able to further increase the precision of the model to an AUC of 0.812 (CI = 0.73–0.89, p < 0.02) resulting in a sensitivity of 85% and a specificity of 72% to predict mortality at 30 days after LVAD implantation. Combining the model with other parameters such as age, sex, and concomitant diseases failed to further improve the accuracy.

Conclusion: Non-invasive liver fibrosis scores are easy to assess as they are calculated from routine laboratory parameters. We have demonstrated that by combining fibrosis-4 and the HUI score, we were able to develop a simple risk model that was able to accurately predict 30-day mortality after LVAD implantation.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025