{"title":"纤维化-4指数可预测急性心力衰竭患者射血分数保留后肾功能的改善。","authors":"Koken Irie, Yosuke Watanabe, Manabu Uematsu, Hiroshi Yokomichi, Yuma Ichikawa, Takeo Horikoshi, Toru Yoshizaki, Juntaro Deyama, Kenji Kuroki, Tsuyoshi Kobayashi, Takamitsu Nakamura, Kazuto Nakamura, Akira Sato","doi":"10.1007/s10157-025-02669-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Improved renal function (IRF) observed in acute heart failure (AHF) is associated with poor prognosis. Since IRF is linked to renal congestion resulting from inadequate decongestion, predicting IRF could enhance management strategies. The Fibrosis-4 (Fib-4) index, originally developed as a marker for liver fibrosis, correlates with hepatic congestion, which is associated with renal congestion, making it a potential predictor of IRF. This study aims to investigate whether the Fib-4 index can predict IRF in patients with AHF and preserved ejection fraction (AHFpEF).</p><p><strong>Methods: </strong>We analyzed 389 patients hospitalized for AHF between April 2004 and March 2022 at Yamanashi University Hospital. All-cause mortality was monitored for 1 year. IRF was defined as a ≥ 20% increase in the estimated glomerular filtration rate (eGFR) compared to admission levels. Preserved ejection fraction was defined as an ejection fraction ≥ 40%.</p><p><strong>Results: </strong>IRF was observed in approximately 21% of patients with AHFpEF. Kaplan-Meier analysis showed that patients with IRF had higher mortality rates than those without IRF (p = 0.03, log-rank test). Multivariable analysis for IRF revealed that the eGFR, albumin level, and a Fib-4 index ≥ 3.24 (determined by receiver-operating characteristic curve) on admission were independent predictors of IRF in patients with AHFpEF.</p><p><strong>Conclusion: </strong>IRF in patients with AHFpEF is associated with poor prognosis. A higher Fib-4 index at admission in AHFpEF can serve as a predictor of IRF.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Fibrosis-4 index can predict improved renal function in acute heart failure with preserved ejection fraction.\",\"authors\":\"Koken Irie, Yosuke Watanabe, Manabu Uematsu, Hiroshi Yokomichi, Yuma Ichikawa, Takeo Horikoshi, Toru Yoshizaki, Juntaro Deyama, Kenji Kuroki, Tsuyoshi Kobayashi, Takamitsu Nakamura, Kazuto Nakamura, Akira Sato\",\"doi\":\"10.1007/s10157-025-02669-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Improved renal function (IRF) observed in acute heart failure (AHF) is associated with poor prognosis. Since IRF is linked to renal congestion resulting from inadequate decongestion, predicting IRF could enhance management strategies. The Fibrosis-4 (Fib-4) index, originally developed as a marker for liver fibrosis, correlates with hepatic congestion, which is associated with renal congestion, making it a potential predictor of IRF. This study aims to investigate whether the Fib-4 index can predict IRF in patients with AHF and preserved ejection fraction (AHFpEF).</p><p><strong>Methods: </strong>We analyzed 389 patients hospitalized for AHF between April 2004 and March 2022 at Yamanashi University Hospital. All-cause mortality was monitored for 1 year. IRF was defined as a ≥ 20% increase in the estimated glomerular filtration rate (eGFR) compared to admission levels. Preserved ejection fraction was defined as an ejection fraction ≥ 40%.</p><p><strong>Results: </strong>IRF was observed in approximately 21% of patients with AHFpEF. Kaplan-Meier analysis showed that patients with IRF had higher mortality rates than those without IRF (p = 0.03, log-rank test). Multivariable analysis for IRF revealed that the eGFR, albumin level, and a Fib-4 index ≥ 3.24 (determined by receiver-operating characteristic curve) on admission were independent predictors of IRF in patients with AHFpEF.</p><p><strong>Conclusion: </strong>IRF in patients with AHFpEF is associated with poor prognosis. A higher Fib-4 index at admission in AHFpEF can serve as a predictor of IRF.</p>\",\"PeriodicalId\":10349,\"journal\":{\"name\":\"Clinical and Experimental Nephrology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-04-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10157-025-02669-w\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10157-025-02669-w","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Fibrosis-4 index can predict improved renal function in acute heart failure with preserved ejection fraction.
Background: Improved renal function (IRF) observed in acute heart failure (AHF) is associated with poor prognosis. Since IRF is linked to renal congestion resulting from inadequate decongestion, predicting IRF could enhance management strategies. The Fibrosis-4 (Fib-4) index, originally developed as a marker for liver fibrosis, correlates with hepatic congestion, which is associated with renal congestion, making it a potential predictor of IRF. This study aims to investigate whether the Fib-4 index can predict IRF in patients with AHF and preserved ejection fraction (AHFpEF).
Methods: We analyzed 389 patients hospitalized for AHF between April 2004 and March 2022 at Yamanashi University Hospital. All-cause mortality was monitored for 1 year. IRF was defined as a ≥ 20% increase in the estimated glomerular filtration rate (eGFR) compared to admission levels. Preserved ejection fraction was defined as an ejection fraction ≥ 40%.
Results: IRF was observed in approximately 21% of patients with AHFpEF. Kaplan-Meier analysis showed that patients with IRF had higher mortality rates than those without IRF (p = 0.03, log-rank test). Multivariable analysis for IRF revealed that the eGFR, albumin level, and a Fib-4 index ≥ 3.24 (determined by receiver-operating characteristic curve) on admission were independent predictors of IRF in patients with AHFpEF.
Conclusion: IRF in patients with AHFpEF is associated with poor prognosis. A higher Fib-4 index at admission in AHFpEF can serve as a predictor of IRF.
期刊介绍：
Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.
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