Prognostic Significance of Plasma Short-Chain Fatty Acid Levels in Assessing Mortality Risk in Patients with Chronic Heart Failure and Sarcopenia

Short-chain fatty acids (SCFAs) are microbial metabolites involved in immune regulation, energy metabolism, and intestinal barrier integrity. Among them, the role of hexanoic acid (C6), predominantly derived from dietary sources, remains poorly understood in chronic heart failure (CHF) and sarcopenia. A total of 636 patients with confirmed CHF were screened between 2019 and 2021. Sarcopenia was diagnosed in 114 patients, with 74 meeting the inclusion criteria for analysis. Plasma levels of SCFAs-including butanoic, propanoic, isobutyric, 2- and 3-methylbutanoic, hexanoic, pentanoic, and 4-methylpentanoic acids-were measured using HPLC-MS/MS. Muscle strength, mass, and physical performance were assessed using handgrip dynamometry, bioelectrical impedance analysis, and SPPB, respectively. All patients showed elevated SCFA levels compared to reference values. Butanoic acid levels exceeded reference values by 32.8-fold, propanoic acid by 10.9-fold, and hexanoic acid by 1.09-fold. Patients with plasma hexanoic acid levels above the 50th percentile had a seven-fold increased mortality risk (OR = 7.10; 95% CI: 1.74-28.9; <i>p</i> < 0.01). Kaplan-Meier analysis confirmed significantly lower survival in this group (<i>p</i> = 0.00051). The mean left ventricular ejection fraction was 41.2 ± 7.5%, and the mean SPPB score was 6.1 ± 1.8, indicating impaired physical performance. Elevated plasma hexanoic acid is associated with poor prognosis in CHF patients with sarcopenia. These findings suggest that C6 may serve as a potential prognostic biomarker and therapeutic target in this population.