FonLiver risk score in patients with tricuspid regurgitation: a 10-year prospective cohort study
J Zhang, K H Yiu, R Guo, W L Gu, H C XuanAbstract
Background and aims
Tricuspid regurgitation (TR) can lead to chronic venous congestion and subsequent end-organ dysfunction. The development of liver fibrosis reflects advanced disease stage. FonLiver risk score (FRS) is a well-established, non-invasive score to assess liver fibrosis in Fontan circulation. We aimed to validate FRS and investigate its prognostic implications in patients with significant TR.
Methods
From 2013 to 2023, patients with at least moderate TR were prospectively enrolled. All patients underwent laboratory testing, vibration-controlled transient elastography, and echocardiographic assessment. FRS was calculated based on liver stiffness measurement and platelet counts. The primary outcome was all-cause mortality; the secondary outcome was a composite event of kidney or liver failure.
Results
Of 368 patients (median age [IQR]: 66.0 [60.0, 70.0] years; 32.9% male) included, 124 patients died over a median follow-up of 5.6 years. FRS demonstrated a strong value in diagnosing cardiac cirrhosis (N=19, prevalence 8.3%) with an AUROC of 0.87 among those underwent multimodal liver screening (N=231). An elevated FRS (defined as a value ≥ -0.93) was observed in 171 patients (46.5%) and was independently associated with higher risk of mortality (HR, 1.30, 95% CI,1.16-1.45, P<0.001). Of those with normal kidney and liver function tests (N=180), 28.3% had elevated FRS, which was linked to increased risks of mortality (HR, 2.51, 95% CI: 1.31-4.79, P=0.005) and the composite event of kidney or liver failure (HR, 3.01, 95% CI: 1.44-6.26, P=0.003).
Conclusion
FRS correlates with the severity of liver fibrosis in patients with significant TR. FRS offers independent prognostic information in addition to standard blood tests and can be incorporated into clinical practice as a portable tool for TR risk stratification.Validation of FRSPrognostic implications of FRS