Introduction

The Fibrosis-4 (FIB-4) index is used to assess the risk of liver fibrosis but is also a cardiovascular risk factor.

Aim

To analyze the impact of FIB-4 on the incidence of contrast-induced nephropathy (CIN) and clinical outcomes in acute coronary syndrome (ACS).

Material and methods

A retrospective study included 1465 patients with ACS who underwent coronary angiography or percutaneous coronary intervention (PCI) and were stratified according to FIB-4 levels: < 1.45, 1.45–3.25, and ≥ 3.25.

Results

The subgroup with FIB-4 index ≥ 3.25 showed the highest incidence of CIN (4.8% vs. 5.9% vs. 10.0%; p = 0.018), as well as the highest mortality rates at 30 days (1.9% vs. 1.8% vs. 8.0%; p < 0.001) and at 365 days (5.2% vs. 6.7% vs. 18.1%; p < 0.001). This subgroup also had the highest combined rates of death or hospitalization at both 30 days (3.1% vs. 3.5% vs. 9.6%; p < 0.001) and 365 days (12.7% vs. 20.3% vs. 30.5%; p < 0.001). In multivariable models, factors associated with 30-day mortality included a history of stroke (HR > 6), occurrence of CIN (HR > 6), and high FIB-4 index group (HR > 3.5). Additionally, high-sensitive troponin T (hs-TnT) levels were associated with a 3% mortality increase with each 100 ng/l increase. For 1-year mortality, multivariable analysis identified male gender (HR = 1.97), high FIB-4 (≥ 3.25, HR = 2.21), and CIN (HR = 2.76) as independent predictors.

Conclusions

The subgroup of patients with a high FIB-4 index is characterized by a higher percentage of CIN, hospitalizations, and deaths from ACS. A high FIB-4 index value is an independent predictor of short- and long-term mortality. The FIB-4 index is an additional risk factor for poor prognosis in patients with ACS.