Abstract 16188: Fibrosis-4 Index in the Evaluation of Non-Ischemic Myocardial Injury in the Emergency Department

Abstract

Introduction: Fibrosis-4 (FIB-4) is a recognized score of liver fibrosis that is associated with ischemic heart disease and cardiac death. The relationship between FIB-4 index and non-ischemic myocardial injury (ni-MI) has not yet been investigated. Hypothesis: There is an association between FIB-4 index and ni-MI in patients admitted to an emergency department (ED). Methods: This retrospective study included consecutive patients presenting at the ED within a six months’ timeframe, with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis. The cohort with ni-MI was compared with the group with normal hs-cTnT values (control group, CG). FIB-4 index was calculated by: {age [years]хAST [U/L]/ [platelet count (10 9 /L)хALT (U/L) 1/2 ]}. Results: A total of 3,853 patients were enrolled, 1,950 (51%) males, 64 [48-78] years, 1,372 (35.6%) with ni-MI. FIB-4 index was higher in the cohort with ni-MI compared to the CG (1.90 [1.28-2.78] vs. 1.01 [0.64-1.49]; p<0.001), with no sex differences (see Figure 1) . After adjustment for other covariates, FIB-4 index was independently associated with ni-MI in overall population (OR 1.468, 95% CI:1.195-1.803; p<0.001), and separately in both males and females (OR 1.385, 95% CI:1.054-1.822; p=0.02 and OR 1.407, 95% CI:1.017-1.946; p=0.039, respectively). FIB-4 index was positively correlated with hs-cTnT (Rho= +0.536, p<0.001), NT-proB-type Natriuretic Peptide (Rho= +0.280, p<0.001) and negatively with estimated glomerular filtration rate (Rho= -0.510, p<0.001). AUC of FIB-4 index for predicting ni-MI in the overall population was 0.790 (optimal cutoff: ≥1.46, sensitivity: 71.9%, specificity: 73.2%). Conclusions: FIB-4 index is independently associated with ni-MI in ED, without sex differences, and positively correlated with the grade of cardiac injury, volume overload and renal dysfunction.