Early postoperative Fibrinogen-to-Albumin Ratio prognosticate 6-month procedural success in patients undergoing orthotopic heart transplantation

Abstract Background The Fibrinogen-to-Albumin ratio (FAR) has emerged as a novel biomarker, integrating liver function and inflammatory reaction with proven prognostic value in heart failure (HF) patients. This study aims to evaluate its significance in advanced HF patients treated with orthotopic heart transplantation (HTx). Methods Mean fibrinogen, albumin and FAR values were analyzed one week post-HTx. The primary endpoint of the study was 6-month all-cause mortality. Regression models incorporating parameters significantly different between survivor and deceased groups (troponin, potassium, asparagine aminotransferase [AST]) were developed to assess predictive value of FAR. Additionally, the Spearman's rank correlation between FAR and inflammatory biomarkers (C-reactive protein [CRP], procalcitonin, white blood cells (WBC)] and liver enzymes [AST, alanine aminotransferase [ALT], gamma-glutamyl transpeptidase [GGTP]) were calculated. Results The analysis included 104 patients undergoing HTx with a median age of 53 years (44.5-62.5), 82% were male, 44% had ischaemic aetiology of HF. Within 6 months post-HTx 17 patients (16%) died. Mean fibrinogen in all patients was (3.18 ± 0.83), albumin (3.17 ± 0.35) and FAR (1.01 ± 0.28). Deceased patients exhibited lower 1 week post HTx mean fibrinogen (2.46 ± 1.13) compared to survivors (3.30 ± 0.70), lower albumin (2.93 ± 0.43) vs. (3.21 ± 0.32), and lower FAR median (0.73, 0.53-1.16) vs. (0.99, 0.88-1.18), all p<0.05. The post-HTx fibrinogen independently predicted death: (RR 0.37, p=0.003, 95% CI [0.19,0.71]), as did post-HTx albumin: (RR 0.21, p=0.05, 95% CI [0.04,1.0]). FAR was also an independent risk factor: (RR 0.08, p=0.009, 95% CI [0.01,0.54]). There were significant correlations between FAR and CRP (R=0.30, p=0.003), and GGTP (R=0.25, p=0.045). FAR was not significantly correlated with procalcitonin, WBC, AST and ALT. Conclusions Early post-HTx fibrinogen, albumin and FAR are independent predictors of an unfavorable prognosis in HF patients undergoing HTx. In contrast to chronic HF, early post-HTx FAR was inversely correlated with mortality. The calculated correlation between FAR, inflammatory markers and liver enzymes suggests limited association with inflammatory processes and liver function in this population.