BMC Cardiovasc Disord. 2026 Jun 22. doi: 10.1186/s12872-026-06148-2. Online ahead of print.
ABSTRACT
BACKGROUND: This study aimed to investigate the associations of multiple noninvasive liver fibrosis scores with cardiovascular-kidney-metabolic (CKM) syndrome severity and clinical outcomes.
METHODS: This retrospective cohort study included 8,592 participants from the National Health and Nutrition Examination Survey 2005-2018. Six noninvasive liver fibrosis scores, including LiverRisk, metabolic dysfunction-associated fibrosis 5 (MAF-5), nonalcoholic fatty liver disease fibrosis score (NFS), Fibrosis-4 (FIB-4), steatosis-associated fibrosis estimator (SAFE), and aspartate aminotransferase-to-platelet ratio index (APRI), were evaluated. Logistic regression was used to assess associations with advanced CKM syndrome. Cox proportional hazards models and Fine-Gray competing-risk models were applied to evaluate associations with all-cause mortality and cardiovascular disease (CVD) mortality, respectively. Restricted cubic spline, subgroup, sensitivity, and incremental prediction analyses were also performed.
RESULTS: The participants had a mean age of 50.82 ± 0.22 years, 51.85% were female, and 12.30% had advanced CKM syndrome. During a median follow-up of 7.42 years, 599 all-cause deaths and 166 CVD deaths occurred. Higher LiverRisk, MAF-5, NFS, FIB-4, and SAFE scores were significantly associated with advanced CKM syndrome, whereas APRI was not. All six fibrosis scores were significantly associated with increased all-cause mortality. For CVD mortality, higher LiverRisk, NFS, FIB-4, and SAFE were significantly associated with increased risk, with corresponding sHRs of 3.84, 3.54, 2.25, and 3.63, respectively (all P < 0.05), whereas MAF-5 and APRI were not significantly associated with CVD mortality. These findings were supported by dose-response analyses and remained materially unchanged in sensitivity analyses.
CONCLUSION: Higher LiverRisk, MAF-5, NFS, FIB-4, and SAFE scores were associated with advanced CKM syndrome, whereas all six scores were associated with all-cause mortality. LiverRisk, NFS, FIB-4, and SAFE showed more consistent associations with CVD mortality.
PMID:42324457 | DOI:10.1186/s12872-026-06148-2