Prognostic value of the fibrinogen-to-albumin ratio (FAR) in patients with chronic heart failure across the different ejection fraction spectrum

ABSTRACT

The ratio of fibrinogen to albumin (FAR) is considered a new inflammatory biomarker and a predictor of cardiovascular disease risk. However, its prognostic value for patients with chronic heart failure (CHF) with different ejection fractions (EFs) remains unclear. A total of 916 hospitalized patients with CHF from January 2017 to October 2021 in the First Affiliated Hospital of Kunming Medical University were included in the study. Death occurred in 417 (45.5%) patients out of 916 patients during a median follow-up time of 750 days. Among these patients, 381 patients suffered from HFrEF (LVEF <40%) and 535 patients suffered from HFpEF or HFmrEF (HFpEF plus HFmrEF, LVEF ≥ 40%). Patients were categorized into high-level FAR (FAR-H) and low-level FAR (FAR-L) groups based on the optimal cut-off value of FAR (9.06) obtained from receiver operating characteristic (ROC) curve analysis. Upon analysing the Kaplan – Meier plots, the incidence of death was significantly higher in all patients with FAR-H and patients in both HF subgroups (p < 0.001). The multivariate Cox proportional hazard analyses indicated that the FAR was an independent predictor of all-cause mortality, regardless of heart failure subtype. (HR 1.115, 95% CI 1.089–1.142, p < 0.001; HFpEF plus HFmrEF, HR 1.109, 95% CI 1.074–1.146, p < 0.0001; HFrEF, HR 1.138, 95% CI 1.094–1.183, p < 0.0001) The optimal cut-off value of FAR in predicting all-cause mortality was 9.06 with an area under the curve value of 0.720 (95% CI: 0.687–0.753, p < 0.001), a sensitivity of 68.8% and a specificity of 65.6%. After adjusting for the traditional indicators (LVEF, Lg BNP, etc.), the new model with the FAR had better prediction ability in patients with CHF. Elevated FAR is an independent predictor of death in CHF and is not related to the HF subtype.

KEYWORDS:

• Fibrinogen/Albumin ratio
• chronic heart failure
• mortality
• prognosis
• inflammation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Sirui Yang, Jiangyuan Pi and Lixing Chen conceptualized and designed the survey, conducted the statistical analyses, drafted the first manuscript and approved the final manuscript as submitted. Sirui Yang and Lixing Chen performed the statistical analysis, was conducive to explaining the data and drafted the first manuscript. Wenfang Ma, Hongxing Zhang, Anyu Xu and Yanqing Liu have been involved in drafting the manuscript and conducted the statistical analyses. Tao Shi, Fazhi Yang, Wenyi Gu and Sirui Yang conducted the data collection and statistical analyses. All authors agreed to the submission of the final manuscript.

Additional information

Funding

This study was supported by the Applied Basic Research Pro-gram of the Science and Technology Hall of Yunnan Province and Kunming Medical University (Project No.202301AY070001-130) and the National Natural Science Foundation of China (Project No. 82000337).