Combination of the Fibrosis 4 Index and Carbohydrate Antigen 125 to Predict Morbidity and Mortality in Acute Heart Failure.

Background: The implementation of the fibrosis 4 (FIB-4) index was initially associated with hepatic dysfunction; however, this index may also provide prognostic information in heart failure (HF). Thus, this study aimed to assess whether combining the FIB-4 and carbohydrate antigen 125 (CA125) indices in patients hospitalized for acute heart failure (AHF) can identify subgroups with differing risks of morbidity and mortality. Methods: This retrospective study included 402 patients consecutively admitted for AHF between January 2023 and December 2024, after excluding elective admissions (n = 403), inter-hospital transfers (n = 232), and low-output cases (n = 51). Patients were stratified into four groups according to the FIB-4 score (<1.3 or high) and CA125 value (≤50 U/mL or high): Group 1 (low FIB-4 + low CA125; n = 43), Group 2 (low FIB-4 + high CA125; n = 57), Group 3 (high FIB-4 + low CA125; n = 117), and Group 4 (high FIB-4 + high CA125; n = 185). Clinical, echocardiographic, therapeutic, and laboratory variables were analyzed, as well as morbidity (HF-related emergency visits and readmissions) and all-cause mortality. Results: Patients with both elevated FIB-4 and CA125 values had a higher prevalence of systemic/mixed congestion ( Conclusions: The FIB-4 index may be a useful indicator in AHF. Elevated values at admission for decompensation, in combination with high CA125 levels, can be used to identify a subgroup of patients with poor short- to medium-term outcomes, particularly in terms of worsening. Further studies are needed to determine the actual utility of the FIB-4 index in the context of AHF.