Hubungan Skor Fibrosis Hati (FIB-4) dengan Kejadian Fibrilasi Atrium pada Pasien Gagal Jantung dengan Fraksi Ejeksi Menurun (HFrEF) di RS. Adam Malik Medan

Abstract

Introduction: Liver fibrosis, which results from chronic congestion in heart failure, indicates a systemic inflammatory response that may lead to atrial remodeling and atrial fibrillation (AF). The Fibrosis-4 (FIB-4) index is a non-invasive tool for assessing hepatic fibrosis. It could serve as a valuable predictor for AF in patients with heart failure with reduced ejection fraction (HFrEF), offering a practical approach for early risk stratification. This study aims to explore the relationship between the FIB-4 score and the incidence of AF in HFrEF patients hospitalized at Adam Malik General Hospital, Medan, providing valuable insights to inform clinical practice and improve patient outcomes Methods: We conducted a retrospective cross-sectional study involving 130 HFrEF patients. FIB-4 scores were computed using age, AST, ALT, and platelet count, while AF was diagnosed via electrocardiogram. We utilized chi-square tests and multivariate logistic regression to analyze the relationship between fibrosis grade and AF occurrence. Results: The average age of participants was 59 years, with males constituting 56.2%. AF was present in 65 patients (50%). The mean FIB-4 score was 2.49, with 22.3% exhibiting low fibrosis, 42.3% moderate fibrosis, and 35.4% high fibrosis. A significant association was found between FIB-4 fibrosis grade and AF (p=0.002). Patients with moderate fibrosis had a 4.951-fold increased risk (OR 4.951; 95% CI 1.742–14.073; p=0.003), while those with high fibrosis had a 5.649-fold increased risk (OR 5.649; 95% CI 1.936–16.483; p=0.002) compared to low fibrosis patients. Conclusion: The FIB-4 score significantly correlates with AF occurrence in HFrEF patients, although further prospective studies are needed to establish causality. Its potential as a simple, cost-effective, and non-invasive screening tool for identifying those at higher risk for AF warrants consideration in clinical practice.