Prognostic value of Heart-failure FAN score in patients with severe aortic stenosis undergoing valve replacement surgery 

Prognostic value of Heart-failure FAN score in patients with severe aortic stenosis undergoing valve replacement surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognostic value of Heart-failure FAN score in patients with severe aortic stenosis undergoing valve replacement surgery Özlem Çakırköse This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8280576/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The left ventricle ejection fraction (LVEF) may be preserved or decreased in aortic stenosis (AS). Aortic stenosis may result in left ventricular diastolic dysfunction and heart failure even without a decrease in the LVEF. The heart and liver are two organs that are closely related. The FAN score which is a liver function marker that comprises the fibrosis-4 index, albumin-bilirubin score (ALBI) and neutrophil-to-lymphocyte ratio (NLR) has recently been demonstrated to have a prognostic impact in heart failure. Objectives: This study investigated prognostic impact of the FAN score in patients undergoing surgery for aortic stenosis with preserved ejection fraction. Methods: After receiving approval from the Institutional Ethics Committee for this single-center, retrospective study, patients were screened to identify those who had undergone an isolated heart valve surgery for severe aortic stenosis with preserved LVEF between December 2015 and December 2024. Baseline demographics, echocardiographic, laboratory and surgical and performance status data were collected. The FAN scores and HF-FAN scores were calculated preoperatively. Results: A total of 86 patients were included in the study. Study patients were divided into survivor and deceased groups based on the survival status. The survivor group included 54 (the mean age 68.8 ± 12.0 years with %51.4 males) patients and deceased group included 32 patients (the mean age 74.3 ± 12.04 years, with %53.4 males). No significant differences were found between the study groups in gender distribution, whereas patients in the deceased group were statistically significantly older. Age, uric acid, ProBNP, NLR, CRP, the FIB-4 index, ALBI score, FAN score and HF-FAN score were identified as independent risk factors for mortality in the univariate and multivariate regression analyses. Furthermore, the ROC analysis revealed that the HF-FAN score was a better prognostic indicator than the FAN score, ALBI score, FIB-4 index and NLR. Conclusion: This study demonstrates that the FAN score is a simple and practical risk assessment tool for postoperative mortality in aortic stenosis with preserved ejection fraction . Moreover, this study revealed the superiority of the HF-FAN score over the original FAN core, in terms of sensitivity and specificity. Figures Figure 1 INTRODUCTION Heart failure is among the leading causes of mortality in the elderly. Aortic stenosis (AS) is the most frequent valvular disease in old age and has been considered as a poor prognostic factor. The prevalence of AS is 13% in people over the age of 75. ( 1 ) The left ventricle ejection fraction (LVEF) may be preserved or decreased in aortic stenosis. Even with a preserved LVEF, left ventricular diastolic dysfunction and heart failure can occur in patients with AS, due to the structural and functional impairment of the myocardium. ( 2 ) The kidney, liver and brain are among the main target organs in heart failure. Heart failure may impact the liver as it causes right-sided heart failure that leads to increased central venous pressure, pulmonary hypertension and end-organ damage. In addition, occurrence of cardiohepatic syndrome is a poor prognostic factor and is associated with a high mortality. ( 3 ) Besides, a close relationship exists between heart failure and inflammation. Neutrophil-to-lymphocyte ratio is a simple and well-known marker of inflammation. Furthermore, NRL is among the poor prognostic factors in patients with heart failure. ( 4 – 5 ) The FAN score that combines the fibrosis-4 index, ALBI score and NLR has recently been defined as an important prognostic marker for urothelial carcinoma. ( 6 ) In addition, its prognostic value has also been demonstrated in patients with heart failure. ( 7 ) However, its impact on postoperative prognosis in patients with aortic stenosis with preserved ejection fraction has remained unknown. In this study, prognostic impact of the FAN score was investigated in patients undergoing surgery for aortic stenosis with preserved ejection fraction. MATERIALS & METHODS Following the approval of the ethics committee, 86 subjects who had undergone isolated cardiac valve surgery for aortic stenosis with normal left ventricular ejection fraction between December 2015 and December 2024 were included in this single-center study, retrospectively. The study was conducted in accordance with the principles of the Helsinki Declaration. The diagnosis of aortic stenosis and preserved EF were made based on recent guidelines. ( 8 – 9 ) This study was approved by the Ethics Committee in Clinical Research (ECCR) of the First Affiliated Hospital of Giresun Medical University (Approval No. KAEK-341). In accordance with Articles 32 and 35 of the Declaration of Helsinki, written informed consent was waived for this retrospective analysis due to its minimal risk and anonymized data usage Exclusion criteria included bicuspid aortic valve, history of coronary artery disease, chronic kidney failure, albuminuria, chronic liver disease, malignancies, thyroid disorders, heart failure (patients with an EF less than 50%), coronary artery disease requiring a bypass graft surgery. Patients receiving albumin replacement therapy, chemotherapy or steroids were also excluded from the study. Key clinical characteristics, preoperative medical therapies, echocardiographic characteristics, and the reason for surgery and surgical techniques were noted. Hypertension, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, coronary artery disease and current medications were thoroughly investigated in all patients. Chronic kidney failure was defined as a glomerular rate less than 60 ml/min for more than 3 months. Hypertension was defined as being on antihypertensive medication or a systolic blood pressure over140 mmHg and a diastolic blood pressure over 90 mmHg in at least three measurements. Diabetes is considered in patients on antidiabetic medications or if at least two fasting blood glucose measurements were higher than 126 mg/dl. Echocardiographic studies All study subjects underwent echocardiographic studies performed by using an iE33 cardiac ultrasound system (Philips Healthcare, Best, The Netherlands) equipped with 2.5–5-MHz transducers and the modified Simpson method was used to calculate ejection fractions. Complete Blood Counts and Blood Chemistry Fasting blood samples were collected from all study subjects in the morning, before the surgery. Neutrophil, lymphocyte, and platelet counts derived from complete blood counts were recorded. Morning blood samples were used to calculate neutrophil-to-lymphocyte ratios. Other blood chemistry and hematology test results were also recorded. Calculations of the Original FAN Score and FAN Score for Heart Failure (HF-FAN score) The original FAN scores were calculated based on the results from fasting blood samples collected before the surgery. The FIB-4 index, ALBI score and NLR were calculated using the following formulas: The FIB-4 index = age (years) × aspartate transaminase (U/L) / (platelet count [10 9 /L] × alanine aminotransferase [U/L]1/2) The ALBI score = (log 10 total bilirubin [mmol/L] × 0.66) + (albumin [g/L] × -0.085) NLR = neutrophil count/lymphocyte count The original FAN score was calculated using following cut-off values: Fib-4 index > 3.5, ALBI score >-2.6, and NLR > 5.0, assigning one point for each index (minimum score 0, maximum score 3) In a study conducted by Maeda D.et al. the FAN score for heart failure (HF-FAN score) was calculated using the median values of the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio in a population of patients with heart failure. The median values for the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio were 2.12, -2.25, and 2.41, respectively. ( 7 ) In this study both original FAN score and HF-FAN score were calculated. Heart Surgery Aortic valve replacement with a mechanical prosthesis was performed on a scheduled basis; no emergency interventions were performed. Patients underwent standard sternotomy and conventional open chest cardiopulmonary bypass (CPB), moderate hypothermia, retrograde pharmacological and hypothermic cardioplegia. A median sternal incision was used to approach the heart. Then, after restoring the integrity of aorta and right atrium, the patient’s body was warmed up to 36.6°C, and the cardiac activity was reestablished. Statistical analysis IBM SPSS 25 Statistics (IBM Corp. Release 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA.) statistical software was used in the analysis. In this study, descriptive statistics (mean, standard deviation, median, minimum, maximum, number and percentages) were used for categorical and continuous variables. Levene’s test was used to assess the homogeneity of variances which is the assumption for parametric tests. The Shapiro-Wilk test was used to test normality. The “Student’s t Test” was used to analyze intergroup differences, if the assumption for parametric tests was met and the Mann Whitney–U test was used, if the assumption for parametric tests was not met. The Fisher’s Exact Test and Pearson’s chi-square test were used to analyze associations between categorical variables. P values less than 0.05 and 0.01 were considered as statistically significant. RESULTS A total of 86 subjects were included in the study. Study subjects were divided into survivor and deceased groups based on survival status. The survivor group included 54 (the mean age 68.8 ± 12.0 years with %51.4 males) patients and deceased group included 32 patients (the mean age 74.5 ± 11.1 years, with %53.4 males). No significant differences were found between the study groups in gender distribution, whereas patients in the deceased group were statistically significantly older. No intergroup differences were found in patients’ medical histories and current medications. Basaline patient characteristics are presented in Table 1 . Table 1 Baseline Clinical Characteristics of Patients SURVIVED (N = 52) Number of patients,(%) DECEASED (n = 34) Number of patients,(%) p Demographic Characteristics Age (years) 68.8 ± 12.0 74.3 ± 12.4 0.001 Male Gender 30(%51.4) 19(%53.4) 0.125 smoking 14(%27) 10(%29) 0.698 Medical history DM 15(%29) 10(%29) 0.584 HT 19(36.5) 12(%35.2) 0.236 HL 9(%17) 7(20.4) 0.256 Stroke 8(%15.3) 5(%14.7) 0.411 COPD 12(%23.0) 7(%20.5) 0.322 MEDIKAL Tedavisi ACE inh. 28(%53.8) 18(%52.9) 0.254 ARB inh. 12(%23.0) 9(%26.4) 0.654 Beta bloker 14(%26.9) 10(%29.4) 0.147 Calcium channel blockade 8(%15.3) 6(%17.6) 0.587 Diüretik 11(%21.1) 8(%23.5) 0.654 Statin treatment 9(%17) 7(%20.1) 0.951 asa 20(%38.4) 13(%38.2) 0.174 DM : Diabetes Mellitus , HT : Hypertension , HL : Hyperlipidemia , COPD : Chronic Obstructive Pulmonary Disease , ACE inh : Angiotensin Convertin Enzyme Inhibitors ARB : Angiotensin Receptor Blockers , ASA : Acetyl Salicylic Acid The analysis of results from laboratory tests and echocardiograms did not reveal significant intergroup differences in hemoglobin levels, WBC counts and kidney function tests. Uric acid levels (6.8 ± 2.1 vs 8.5 ± 2.2 p:0.001), the FAN score (1.41 ± 0.54 vs. 2.5 ± 0.78 p:0.001), the FIB-4 index(1.81 ± 0.65 vs. 3.1 ± 1.21 p:0.001), the ALBI score (-2.96 ± 0.21 vs. -2.42 ± 0.11 p:0.001), C-reactive protein (15.5 ± 1.4 vs. 26.15 ± 1.6 p:0.001), ProBNP (2021 ± 650 vs. 3290 ± 851 p:0.001), NLR (3.94 ± 0.58 vs. 6.71 ± 1.59 p:0.001), and the HF-FAN score (1.64 ± 0.69 vs 3.4 ± 0.84 p:0.001) were statistically significantly higher in the deceased group whereas blood albumin levels (4.1 ± 1.1 vs. 2.9 ± 1.5 p:0.001) were statistically significantly higher in the survivor group. Echocardiograms were comparables between the two groups. (Table 2 ) Table 2 Intergroup Comparisons of Laboratory and Echocardiographic Variables SURVIVOR GROUP (n = 54) DECEASED GROUP (n = 32) p-value Glucose (mg/dl) 181.2 ± 91.5 171.7 ± 90.8 0.512 WBC (µL) 12.1 ± 2.3 11.9 ± 1.7 0.125 Hb (mg/dl) 14.5 ± 1.2 13.5 ± 1.1 0.236 BUN (mg/dL) 34.2 ± 16.2 32.5 ± 17.9 0.214 Cr (mg/dL) 0.78 ± 0.25 0.82 ± 0.21 0.211 Na (mmol/L) 134.1 ± 1.7 135.2 ± 2.3 0.113 K (mmol/L) 4.24 ± 1.11 4.31 ± 1.13 0.156 NLR 3.94 ± 0.58 6.71 ± 1.59 0.001 Uric Acid (mg/dL) 6.8 ± 2.1 8.5 ± 2.2 0.001 ProBNP (pg/mL) 2021 ± 650 3290 ± 851 0.001 FAN score 1.41 ± 0.54 2.5 ± 0.78 0.001 HF-FAN score 1.64 ± 0.69 3.4 ± 0.84 0.001 FIB-4 index 1.81 ± 0.65 3.1 ± 1.21 0.001 ALBI SCORE -2.96 ± 0.21 -2.42 ± 0.11 0.001 Albumin (g/l) 4.1 ± 1.1 2.9 ± 1.5 0.001 LDH (g/dL) 264.2 ± 134.1 265.25 ± 168.2 0.574 CRP (mg/L) 15.5 ± 1.4 26.15 ± 1.6 0.001 Troponin 45.14 ± 24.11 47.7 ± 19.1 0.115 D-dimer 2.52 ± 1.61 2.62 ± 1.1 0.232 ECHOCARDIOGRAPHIC VARIABLES LVEF (%) 58 ± 4.2 56 ± 6.9 0.654 LA diameter (cm) 3.78 ± 0.36 3.85 ± 0.31 0.124 LVEDD (cm) 4.45 ± 0.29 4.75 ± 0.33 0.321 LVESD (cm) 2.75 ± 0.41 2.80 ± 0.65 0.456 IVS (cm) 1.15 ± 0.23 1.21 ± 0.14 0.254 PW (cm) 1.12 ± 0.10 1.11 ± 0.12 0.784 Aortic annulus (cm) 3.41 ± 0.15 3.42 ± 0.14 0.171 SPAP (mmHg) 21.53 ± 11.23 25.05 ± 11.4 0.211 WBC : White Blood Cells, Hb : Hemoglobin, BUN : Blood urea nitrogen Cr : Creatinine Na : Sodium, K : Potassium CRP : C- Reactive Protein LDH : Lactate Dehydrogenase;, EF : Ejection fraction, LA, left atrium; LVEDD, left ventricular end-diastolic diameter; LVEF , left ventricular ejection fraction; LVESD , left ventricular end-systolic diameter; SPAP , systolic pulmonary arterial pressure. The analysis of intraoperative and postoperative data revealed that the CPB time (min) (86.5 ± 14.8 vs. 124.4 ± 42 p:0.001), ICU length of stay(h) (26.33 ± 1.82 vs. 62.12 ± 42.50 p:<0.001), Hospital length of stay (days) (6.53 ± 1.42 vs. 9.41 ± 3.22 p:0.001) were statistically significantly higher in the deceased group. (Table 3 ) Table 3 Intraoperative and postoperative data SURVIVOR GROUP (n = 54) DECEASED GROUP (n = 32) p-value CPB time (min) 86.5 ± 14.8 124.4 ± 42 0.001 CC time (min) 64.2 ± 19.9 72.4 ± 21.3 0.369 Drainage (ml) 432.5 ± 115.4 425.0 ± 125.5 0.236 Time to extubation (h) 7.53 ± 1.65 11.50 ± 4.60 0.152 ICU length of stay (h) 26.33 ± 1.82 62.12 ± 42.50 < 0.001 Hospital length of stay (days) 6.53 ± 1.42 9.41 ± 3.22 0.001 Number of patients with neurological complications (%, n) 0 (0) 0 (0 — CPB, cardiopulmonary bypass; ICU, intensive care unit; In the univariate and multivariate regression analyses, age (OR: 1.414 95%GI: 1.120–1.610 p: 0.001), blood uric acid (OR: 1.925 95%GI: 1.311–2.511 p: 0.001), ProBNP (OR: 1.851 95%GI: 1.325–2.358 p: 0.001),NLR (OR: 1.432 95%GI: 1.121–1.521 p: 0.001), CRP (OR: 1.543 95%GI: 1.321–1.961 p: 0.001), the FIB-4 index (OR: 2.789 95%GI: 1.475–3.124 p: 0.001), the ALBI score (OR: 2.412 95%GI: 1.784–3.457 p: 0.001), the FAN score (OR: 3.614 95%GI: 2.211–4.910 p: 0.001), and the HF-FAN score (OR: 4.214 95%GI: 2.984–6.124 p: 0.001) were found to be independent risk factors for mortality.(Table 4 ) Table 4 Effects of Different Variables on Mortality in the Univariate and Multivariate Logistic Regression Analyses Univariate Multivariate OR %95 CI p OR %95 CI P-value Lower Upper Lower bound Upper bound Age 1.651 1.251 1.974 0.000 1.414 1.120 1.610 0.001 HT 1.362 1.112 1.651 0.000 1.521 1.321 1.812 0.001 CRP 1.231 1.110 1.411 0.000 1.543 1.321 1.961 0.001 proBNP 1.415 1.225 1.584 0.000 1.851 1.325 2.358 0.001 Uric acid 1.634 1.231 1.912 0.000 1.925 1.311 2.511 0.001 NLR 1.285 1.112 1.452 0.014 1.432 1.121 1.521 0.001 FAN score 2.915 1.443 3.902 0.000 2.914 2.211 3.510 0.001 HF-FAN score 1.412 1.214 1.564 0.000 4.214 2.984 6.124 0.001 FIB-4 index 2.112 1.512 3.545 0.000 2.789 1.475 3.124 0.001 ALBI score 1.987 1.457 3.456 0.000 2.412 1.784 3.457 0.001 HT: Hypertension, CRP: C-Reactive Protein, ALBI score: Albumin-Bilirubin Score Cut-off value: 1.63; Sensitivity 70.5%; Specificity: 68.1% In the ROC analysis, the area under the curve (AUC) of the HF-FAN score was calculated as 0.775, the cut-off value was 1.63 with a sensitivity of 70.5% and a specificity of 68.1%. The HF-FAN score has proven to be a better prognostic indicator compared to the FAN score (AUC: 0.717), the ALBI score (AUC: 0.649), the FIB-4 index (AUC: 0.606), and NLR (AUC: 0.596). (Fig. 1 ) DISCUSSION This study investigated the predictive value of the FAN score for mortality risk in patients undergoing surgery for severe aortic stenosis with preserved ejection fraction for the first time. In line with previous studies, age, blood uric acid level, CRP level, the FIB-4 index, ALBI score, and proBNP were found to be independent risk factors for mortality in our study. Aging is associated with frailty, pro-inflammatory state, increased comorbidities and immune system disorders, as well as structural and molecular changes in the heart valves, in addition to calcification and myxoid degeneration in valvular endothelial cells.( 10 – 11 ) In a prospective study, Nowicki et al. reported that aortic valve surgery mortality increased with age, with an increase of 1.96 times in patients in the age group 70 to 75 and 3.41 times in patients in the age group 80 to 95.( 12 ) Uric acid is the end-product of purine metabolism. Several studies have demonstrated that pro-oxidant and pro-inflammatory effects of high serum uric acid levels can increase myeloperoxidase activity necessary for the activation of neutrophils and monocytes and interleukin (IL)-1 beta and can cause endothelial dysfunction and proliferation of smooth muscle cells. ( 13 – 14 ) Based on previous studies, post-myocardial infarction may be associated with heart failure as well as the severity of aortic valve disease. ( 15 ) Lazzeroni et al. demonstrated that mortality rates following heart valve surgery were two times higher in patients with higher serum uric acid levels compared those with a normal serum uric acid concentration. Moreover, a positive correlation was found between uric acid levels and mortality rates. ( 16 ) C-reactive protein (CRP) is a key acute phase reactant, and associations exist between CRP levels and elevated blood pressure, myocardial infarction, chronic heart failure and diabetes mellitus. ( 17 – 18 ) In a study conducted by Duchrowski et al., mortality rate following heart surgery was 1.64 times higher in patients with higher CRP levels. Natriuretic peptid is an important biomarker of heart failure and higher preoperative or postoperative BNP levels are associated with poor prognosis in patients undergoing heart surgery. In addition, high BNP levels are associated with the need for inotropes and mechanical circulatory support. ( 19 ) Jiang H. et al. reported that among patients who underwent surgery for aortic stenosis with heart failure, mortality rates were 6.2 times higher in those with higher BNP levels. ( 20 ) The prognostic value of the FAN score that includes FIB-4 index, ALBI score and NLR has been recently recognized. FIB-4 index is a simple and non-invasive key marker of hepatic fibrosis and has a prognostic value in heart failure particularly in patients with increased right ventricular pressure. ( 21 – 22 ) In a study conducted in patients undergoing transcatheter aortic valve replacement, Sudo M. et al. reported that patients with high FIB-4 index had a 1.75- fold higher risk of mortality. Furthermore, high FIB-4 index has been associated with right-sided heart failure. ( 23 ) The ALBI score is a new prognostic marker and is a key indicator of liver functions in patients with hepatocellular carcinoma. The ALBI score is derived from serum albumin and bilirubin levels which are easily measured blood tests, and it is an important marker with prognostic value for liver functions and disorders. ( 24 – 25 ) The ALBI score is associated with liver functions, but it also has prognostic importance in hepatocellular carcinoma, heart disease and coronavirus disease. ( 26 – 27 ) In a study conducted by Duman ZM et al., a high ALBI score and acute kidney failure were found to be independent risk factors for in-hospital mortality in patients undergoing isolated or combined heart valve surgery. NLR is a marker of systemic inflammation and provides prognostic information for inflammatory processes as well as short-term and long-term prognostic information for several heart diseases including heart failure, myocardial infarction, heart valve disorders. ( 28 ) Shahim B. et al. reported that a high NLR might be a prognostic indicator for mortality and re-hospitalization in patients undergoing surgery for severe aortic stenosis. Furthermore, a high NLR was found to be an independent risk factor for poor cardiac function in the long and short term. ( 29 ) In the literature, there are limited cardiovascular disease trials involving the FAN score. Meade et al. screened 1505 patients with heart failure between 2015 and 2020. That study aimed to investigate prognostic value of the FAN score as well as the HF score. Patients were divided into four groups based on HF-FAN scores (0, 1,2, or 3). No significant intergroup differences were found in the left ventricular ejection fraction (LVEF). Furthermore, the rates of patients with a LVEF > 50% did not differ among the groups. However, the mean age, BNP levels and the diameter of the inferior vena cava were higher in the group of patients with a HF-FAN score of 3, compared to the other groups. The Receiver Operating Characteristic analysis indicated that the prognostic value of the HF-FAN score was higher than that of the original FAN score, ALBI score and NRL while AUC values for the HF-FAN score, original FAN score, ALBI score and NRL were 0.633, 0.562, 0.576 and 0.577, respectively. In line with the current literature, the original FAN score and HF-FAN score were found to be independent predictors for mortality in our study. Furthermore, the cut-off value for HF-FAN score was found to be 1.63 with a sensitivity of 70.5% and specificity of 68.1%, and the HF-FAN score was found to be a better prognostic indicator compared to the original FAN score, in line with the current literature. Study Limitations The main limitations of the study included its single-center design and small sample size. Right heart functions were not measured by echocardiograms and a right heart catheterization was not performed preoperatively, in study patients. Optimal medical therapies, including sacubitril/ valsartan and sodium-glucose cotransporter-2 inhibitors that have proven beneficial in heart failure, were not investigated in study patients. In addition, only preoperative scores of study patients were collected but postoperative scores were not measured. CONCLUSION This study demonstrates that the FAN score is a simple and practical risk assessment tool for postoperative mortality in aortic stenosis with preserved ejection fraction. Moreover, this study revealed the superiority of the HF-FAN score over the original FAN core in terms of sensitivity and specificity. Declarations Funding Not applicable. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee in Clinical Research (ECCR) of the First Affiliated Hospital of Giresun Medical University (Approval No. KAEK-341). In accordance with Articles 32 and 35 of the Declaration of Helsinki, written informed consent was waived for this retrospective analysis due to its minimal risk and anonymized data usage Declaration, the requirement for written informed consent was waived by the ECCR due to the retrospective nature of the study, which involved minimal risk to participants and preserved their anonymity. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Acknowledgements Not applicable. Authors’ contributions Authors’ contributions: çakırköseÖ: conceptualization, data curation, writing - original draft. ÇakırköseÖ: data curation, resources. çakırköseÖ: writing – review & editing. çakırköseÖ: methodology. çakırköseÖ: resources. çakırköseÖ: visualization. çakırköseÖ: resources. çakırköseÖ: conceptualization, writing – review & editing, project administration Conflict of interest: None declared. Note : We didn't use any artificial intelligence (AI) assisted technologies (such as Large Language Models [LLMs], chatbots, or image creators) in the production of submitted work. Clinical trial number : not applicable. References Kodra A, Kim M. Calcific Aortic Valve Stenosis with Aging and Current Development in its Pathophysiology. Int J Angiol. 2022;31(4):229–31. 10.1055/s-0042-1758382 . Hita A, et al. Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making. Cardiol J. 2015;22(6):613–21. 10.5603/CJ.a2015.0034 . Aspromonte N, Fumarulo I, Petrucci L, et al. The Liver in Heart Failure: From Biomarkers to Clinical Risk. Int J Mol Sci. 2023;24(21):15665. 10.3390/ijms242115665 . Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474–88. 10.4149/BLL_2021_078 . Wu CC, Wu CH, Lee CH, Cheng CI. Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005–2016. BMC Cardiovasc Disord. 2023;23(1):312. 10.1186/s12872-023-03316-6 . Yamashita S, Hamamoto S, Furukawa J, et al. Prognostic impact of FAN score in patients receiving nivolumab plus ipilimumab for metastatic renal cell carcinoma. Sci Rep. 2024;14(1):12398. 10.1038/s41598-024-63403-2 . Maeda D, Kanzaki Y, Sakane K. Prognostic Value of the FAN Score, a Combination of the Fibrosis-4 Index, Albumin-Bilirubin Score and Neutrophil-Lymphocyte Ratio, in Patients Hospitalized with Heart Failure. Int Heart J. 2022;63(6):1121–7. 10.1536/ihj.22-338 . Members WC, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2021;162(2):e183–353. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed). 2022;75(6):524. Dent E, Martin FC, Bergman H. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376–86. 10.1016/S0140-6736(19)31785-4 . Di Vito A, Donato A, Presta I, et al. Extracellular Matrix in Calcific Aortic Valve Disease: Architecture, Dynamic and Perspectives. Int J Mol Sci. 2021;22(2):913. 10.3390/ijms22020913 . Nowicki ER, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg. 2004;77(6):1966–77. 10.1016/j.athoracsur.2003.12.035 . Saito Y, Tanaka A, Node K, et al. Uric acid and cardiovascular disease: A clinical review. J Cardiol. 2021;78(1):51–7. 10.1016/j.jjcc.2020.12.013 . Kimura Y, Tsukui D, Kono H, et al. Uric Acid in Inflammation and the Pathogenesis of Atherosclerosis. Int J Mol Sci. 2021;22(22):12394. 10.3390/ijms222212394 . Zhang J, Lei W, Zhou J, et al. Uric acid promotes aortic valve calcification via mediating valve interstitial cell osteogenic differentiation and endothelial dysfunction. FASEB J. 2025;39(6):e70437. 10.1096/fj.202402831R . Lazzeroni D, et al. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery. Eur J Prev Cardiol. 2018;25(2):119–26. 10.1177/2047487317744045 . Epub 2017 Nov 22. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754. 10.3389/fimmu.2018.00754 . Zhou HH, Tang YL, Xu TH, et al. C-reactive protein: structure, function, regulation, and role in clinical diseases. Front Immunol. 2024;15:1425168. 10.3389/fimmu.2024.1425168 . Cao Z, Jia Y, Zhu BBNP. NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine. nt J Mol Sci. 2019;20(8):1820. 10.3390/ijms20081820 . Jiang H, Vánky F, Hultkvist H. NT-proBNP and postoperative heart failure in surgery for aortic stenosis. Open Heart. 2019;6(1):e001063. 10.1136/openhrt-2019-001063 . Kjaergaard M, Lindvig KP, Thorhauge KH. Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease. J Hepatol. 2023;79(2):277–86. 10.1016/j.jhep.2023.04.002 . Seo YG, Polyzos SA, Park KH, et al. Fibrosis-4 Index Predicts Long-Term All-Cause, Cardiovascular and Liver-Related Mortality in the Adult Korean Population. Clin Gastroenterol Hepatol. 2023;21(13):3322–35. 10.1016/j.cgh.2023.04.026 . Sudo M, Shamekhi J, Sedaghat A, et al. Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol. 2022;111(12):1367–76. 10.1007/s00392-022-02055-6 . Deng M, Ng SWY, Cheung ST, et al. Clinical application of Albumin-Bilirubin (ALBI) score: The current status. Surgeon. 2020;18(3):178–86. 10.1016/j.surge.2019.09.002 . Kariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI Score for Predicting Hepatocellular Carcinoma Prognosis. Liver Cancer. 2020;9(6):734–43. 10.1159/000508971 . Wu PJ, Feng IC, Lai CC, et al. The mortality of hospitalized patients with COVID-19 and non-cirrhotic chronic liver disease: a retrospective multi-center study. PeerJ. 2023;11:e16582. 10.7717/peerj.16582 . Matsue Y, Kagiyama N, Yamaguchi T. Clinical and Prognostic Values of ALBI Score in Patients With Acute Heart Failure. Heart Lung Circ. 2020;29(9):1328–37. 10.1016/j.hlc.2019.12.003 . Duman ZM, Timur B, Albumin-Bilirubin Score. A Novel Mortality Predictor in Valvular Surgery. Braz J Cardiovasc Surg. 2023;38(2):271–7. 10.21470/1678-9741-2022-0008 . Shahim B, Redfors B, Lindman BR, et al. Neutrophil-to-Lymphocyte Ratios in Patients Undergoing Aortic Valve Replacement: The PARTNER Trials and Registries. Am Heart Assoc. 2022;11(11):e024091. 10.1161/JAHA.121.024091 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8280576","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584719789,"identity":"b3b68323-410d-4e7d-b6eb-011e77baefda","order_by":0,"name":"Özlem Çakırköse","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYHACZoYEIATSB4CEhAwpWthAhAQPcVoYwFp4DEA8wlr42Q8/Nni4J01Ovr3n86sbNRY8DOyHj27Ap0WyJ804IeFZjrHBmbPbrHOOAR3Gk5Z2A58WgxsMxgcSDlQkbpDI3WacwwbUIsFjRkAL+2ewlvnz3zwzzvlHlBYeoMMO5CQ23OBhfpzbRoQWyZ6cYoOEA2lAv6SZMef2SfCwEfILP/vxzZI/DiQDQ+zw48853+rkgGF4DK8WZMAmASaJVQ4CzB9IUT0KRsEoGAUjBwAAQFRHMqofk+oAAAAASUVORK5CYII=","orcid":"","institution":"Giresun University Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Özlem","middleName":"","lastName":"Çakırköse","suffix":""}],"badges":[],"createdAt":"2025-12-04 14:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8280576/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8280576/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101861664,"identity":"22d21445-329e-4e25-8a6f-cb13254a4658","added_by":"auto","created_at":"2026-02-04 11:47:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137979,"visible":true,"origin":"","legend":"\u003cp\u003eCut-off value: 1.63; Sensitivity 70.5%; Specificity: 68.1%\u003c/p\u003e","description":"","filename":"floatimage151.png","url":"https://assets-eu.researchsquare.com/files/rs-8280576/v1/353cb26ab5f8b150da05678b.png"},{"id":108413227,"identity":"db86b041-d34e-4947-a3fe-6858a3d6349b","added_by":"auto","created_at":"2026-05-04 10:40:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":529026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8280576/v1/02a7131a-4938-4dc0-9cb3-93a227fb3077.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognostic value of Heart-failure FAN score in patients with severe aortic stenosis undergoing valve replacement surgery ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHeart failure is among the leading causes of mortality in the elderly. Aortic stenosis (AS) is the most frequent valvular disease in old age and has been considered as a poor prognostic factor. The prevalence of AS is 13% in people over the age of 75. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The left ventricle ejection fraction (LVEF) may be preserved or decreased in aortic stenosis. Even with a preserved LVEF, left ventricular diastolic dysfunction and heart failure can occur in patients with AS, due to the structural and functional impairment of the myocardium. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe kidney, liver and brain are among the main target organs in heart failure. Heart failure may impact the liver as it causes right-sided heart failure that leads to increased central venous pressure, pulmonary hypertension and end-organ damage. In addition, occurrence of cardiohepatic syndrome is a poor prognostic factor and is associated with a high mortality. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Besides, a close relationship exists between heart failure and inflammation. Neutrophil-to-lymphocyte ratio is a simple and well-known marker of inflammation. Furthermore, NRL is among the poor prognostic factors in patients with heart failure. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe FAN score that combines the fibrosis-4 index, ALBI score and NLR has recently been defined as an important prognostic marker for urothelial carcinoma. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) In addition, its prognostic value has also been demonstrated in patients with heart failure. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) However, its impact on postoperative prognosis in patients with aortic stenosis with preserved ejection fraction has remained unknown.\u003c/p\u003e \u003cp\u003eIn this study, prognostic impact of the FAN score was investigated in patients undergoing surgery for aortic stenosis with preserved ejection fraction.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cp\u003eFollowing the approval of the ethics committee, 86 subjects who had undergone isolated cardiac valve surgery for aortic stenosis with normal left ventricular ejection fraction between December 2015 and December 2024 were included in this single-center study, retrospectively. The study was conducted in accordance with the principles of the Helsinki Declaration. The diagnosis of aortic stenosis and preserved EF were made based on recent guidelines. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e This study was approved by the Ethics Committee in Clinical Research (ECCR) of the First Affiliated Hospital of Giresun Medical University (Approval No. KAEK-341). In accordance with Articles 32 and 35 of the Declaration of Helsinki, written informed consent was waived for this retrospective analysis due to its minimal risk and anonymized data usage\u003c/p\u003e \u003cp\u003eExclusion criteria included bicuspid aortic valve, history of coronary artery disease, chronic kidney failure, albuminuria, chronic liver disease, malignancies, thyroid disorders, heart failure (patients with an EF less than 50%), coronary artery disease requiring a bypass graft surgery. Patients receiving albumin replacement therapy, chemotherapy or steroids were also excluded from the study.\u003c/p\u003e \u003cp\u003eKey clinical characteristics, preoperative medical therapies, echocardiographic characteristics, and the reason for surgery and surgical techniques were noted. Hypertension, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, coronary artery disease and current medications were thoroughly investigated in all patients. Chronic kidney failure was defined as a glomerular rate less than 60 ml/min for more than 3 months. Hypertension was defined as being on antihypertensive medication or a systolic blood pressure over140 mmHg and a diastolic blood pressure over 90 mmHg in at least three measurements. Diabetes is considered in patients on antidiabetic medications or if at least two fasting blood glucose measurements were higher than 126 mg/dl.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEchocardiographic studies\u003c/h2\u003e \u003cp\u003eAll study subjects underwent echocardiographic studies performed by using an iE33 cardiac ultrasound system (Philips Healthcare, Best, The Netherlands) equipped with 2.5\u0026ndash;5-MHz transducers and the modified Simpson method was used to calculate ejection fractions.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eComplete Blood Counts and Blood Chemistry\u003c/h3\u003e\n\u003cp\u003eFasting blood samples were collected from all study subjects in the morning, before the surgery. Neutrophil, lymphocyte, and platelet counts derived from complete blood counts were recorded. Morning blood samples were used to calculate neutrophil-to-lymphocyte ratios. Other blood chemistry and hematology test results were also recorded.\u003c/p\u003e\n\u003ch3\u003eCalculations of the Original FAN Score and FAN Score for Heart Failure (HF-FAN score)\u003c/h3\u003e\n\u003cp\u003eThe original FAN scores were calculated based on the results from fasting blood samples collected before the surgery. The FIB-4 index, ALBI score and NLR were calculated using the following formulas:\u003c/p\u003e \u003cp\u003eThe FIB-4 index\u0026thinsp;=\u0026thinsp;age (years) \u0026times; aspartate transaminase (U/L) / (platelet count [10\u003csup\u003e9\u003c/sup\u003e/L] \u0026times; alanine aminotransferase [U/L]1/2)\u003c/p\u003e \u003cp\u003eThe ALBI score = (log\u003csub\u003e10\u003c/sub\u003e total bilirubin [mmol/L] \u0026times; 0.66) + (albumin [g/L] \u0026times; -0.085)\u003c/p\u003e \u003cp\u003eNLR\u0026thinsp;=\u0026thinsp;neutrophil count/lymphocyte count\u003c/p\u003e \u003cp\u003eThe original FAN score was calculated using following cut-off values: Fib-4 index\u0026thinsp;\u0026gt;\u0026thinsp;3.5, ALBI score \u0026gt;-2.6, and NLR\u0026thinsp;\u0026gt;\u0026thinsp;5.0, assigning one point for each index (minimum score 0, maximum score 3)\u003c/p\u003e \u003cp\u003eIn a study conducted by Maeda D.et al. the FAN score for heart failure (HF-FAN score) was calculated using the median values of the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio in a population of patients with heart failure. The median values for the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio were 2.12, -2.25, and 2.41, respectively. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this study both original FAN score and HF-FAN score were calculated.\u003c/p\u003e\n\u003ch3\u003eHeart Surgery\u003c/h3\u003e\n\u003cp\u003eAortic valve replacement with a mechanical prosthesis was performed on a scheduled basis; no emergency interventions were performed. Patients underwent standard sternotomy and conventional open chest cardiopulmonary bypass (CPB), moderate hypothermia, retrograde pharmacological and hypothermic cardioplegia. A median sternal incision was used to approach the heart. Then, after restoring the integrity of aorta and right atrium, the patient\u0026rsquo;s body was warmed up to 36.6\u0026deg;C, and the cardiac activity was reestablished.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIBM SPSS 25 Statistics (IBM Corp. Release 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA.) statistical software was used in the analysis. In this study, descriptive statistics (mean, standard deviation, median, minimum, maximum, number and percentages) were used for categorical and continuous variables. Levene\u0026rsquo;s test was used to assess the homogeneity of variances which is the assumption for parametric tests. The Shapiro-Wilk test was used to test normality. The \u0026ldquo;Student\u0026rsquo;s t Test\u0026rdquo; was used to analyze intergroup differences, if the assumption for parametric tests was met and the Mann Whitney\u0026ndash;U test was used, if the assumption for parametric tests was not met. The Fisher\u0026rsquo;s Exact Test and Pearson\u0026rsquo;s chi-square test were used to analyze associations between categorical variables. P values less than 0.05 and 0.01 were considered as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 86 subjects were included in the study. Study subjects were divided into survivor and deceased groups based on survival status. The survivor group included 54 (the mean age 68.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0 years with %51.4 males) patients and deceased group included 32 patients (the mean age 74.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1 years, with %53.4 males). No significant differences were found between the study groups in gender distribution, whereas patients in the deceased group were statistically significantly older. No intergroup differences were found in patients\u0026rsquo; medical histories and current medications. Basaline patient characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Clinical Characteristics of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSURVIVED\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003cp\u003eNumber of patients,(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDECEASED\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003cp\u003eNumber of patients,(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDemographic Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(%51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(%53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(%27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(%29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(%29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(%29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(%35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(%17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(%15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(%14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(%23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(%20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMEDIKAL Tedavisi\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACE inh.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(%53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(%52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARB inh.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(%23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(%26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeta bloker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(%26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(%29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium channel blockade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(%15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(%17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDi\u0026uuml;retik\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(%21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(%23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatin treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(%17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(%20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003easa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(%38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(%38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eDM\u003c/b\u003e: \u003cem\u003eDiabetes Mellitus\u003c/em\u003e, \u003cb\u003eHT\u003c/b\u003e: \u003cem\u003eHypertension\u003c/em\u003e, \u003cb\u003eHL\u003c/b\u003e: \u003cem\u003eHyperlipidemia\u003c/em\u003e, \u003cb\u003eCOPD\u003c/b\u003e: \u003cem\u003eChronic Obstructive Pulmonary Disease\u003c/em\u003e, \u003cb\u003eACE inh\u003c/b\u003e: \u003cem\u003eAngiotensin Convertin Enzyme Inhibitors\u003c/em\u003e \u003cb\u003eARB\u003c/b\u003e: \u003cem\u003eAngiotensin Receptor Blockers\u003c/em\u003e, \u003cb\u003eASA\u003c/b\u003e: \u003cem\u003eAcetyl Salicylic Acid\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe analysis of results from laboratory tests and echocardiograms did not reveal significant intergroup differences in hemoglobin levels, WBC counts and kidney function tests. Uric acid levels (6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 vs 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 p:0.001), the FAN score (1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54 vs. 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78 p:0.001), the FIB-4 index(1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65 vs. 3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21 p:0.001), the ALBI score (-2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 vs. -2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11 p:0.001), C-reactive protein (15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 vs. 26.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 p:0.001), ProBNP (2021\u0026thinsp;\u0026plusmn;\u0026thinsp;650 vs. 3290\u0026thinsp;\u0026plusmn;\u0026thinsp;851 p:0.001), NLR (3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 vs. 6.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 p:0.001), and the HF-FAN score (1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 vs 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 p:0.001) were statistically significantly higher in the deceased group whereas blood albumin levels (4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 vs. 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 p:0.001) were statistically significantly higher in the survivor group. Echocardiograms were comparables between the two groups. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntergroup Comparisons of Laboratory and Echocardiographic Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSURVIVOR GROUP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDECEASED GROUP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181.2\u0026thinsp;\u0026plusmn;\u0026thinsp;91.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e171.7\u0026thinsp;\u0026plusmn;\u0026thinsp;90.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCr (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNa (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e135.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUric Acid (mg/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProBNP (pg/mL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2021\u0026thinsp;\u0026plusmn;\u0026thinsp;650\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3290\u0026thinsp;\u0026plusmn;\u0026thinsp;851\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFAN score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHF-FAN score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFIB-4 index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALBI SCORE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin (g/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264.2\u0026thinsp;\u0026plusmn;\u0026thinsp;134.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e265.25\u0026thinsp;\u0026plusmn;\u0026thinsp;168.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e26.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTroponin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.14\u0026thinsp;\u0026plusmn;\u0026thinsp;24.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e47.7\u0026thinsp;\u0026plusmn;\u0026thinsp;19.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eECHOCARDIOGRAPHIC VARIABLES\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLA diameter (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDD (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVESD (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVS (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePW (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic annulus (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPAP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e25.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eWBC\u003c/b\u003e: White Blood Cells, \u003cb\u003eHb\u003c/b\u003e: Hemoglobin, \u003cb\u003eBUN\u003c/b\u003e: Blood urea nitrogen \u003cb\u003eCr\u003c/b\u003e: Creatinine \u003cb\u003eNa\u003c/b\u003e: Sodium, \u003cb\u003eK\u003c/b\u003e: Potassium \u003cb\u003eCRP\u003c/b\u003e: C- Reactive Protein \u003cb\u003eLDH\u003c/b\u003e: Lactate Dehydrogenase;, \u003cb\u003eEF\u003c/b\u003e: Ejection fraction, LA, left atrium; LVEDD, left ventricular end-diastolic diameter; \u003cb\u003eLVEF\u003c/b\u003e, left ventricular ejection fraction; \u003cb\u003eLVESD\u003c/b\u003e, left ventricular end-systolic diameter; \u003cb\u003eSPAP\u003c/b\u003e, systolic pulmonary arterial pressure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe analysis of intraoperative and postoperative data revealed that the CPB time (min) (86.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.8 vs. 124.4\u0026thinsp;\u0026plusmn;\u0026thinsp;42 p:0.001), ICU length of stay(h) (26.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 vs. 62.12\u0026thinsp;\u0026plusmn;\u0026thinsp;42.50 p:\u0026lt;0.001), Hospital length of stay (days) (6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 vs. 9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22 p:0.001) were statistically significantly higher in the deceased group. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntraoperative and postoperative data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSURVIVOR GROUP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDECEASED\u003c/p\u003e \u003cp\u003eGROUP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCPB time (min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e86.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e124.4\u0026thinsp;\u0026plusmn;\u0026thinsp;42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrainage (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e432.5\u0026thinsp;\u0026plusmn;\u0026thinsp;115.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e425.0\u0026thinsp;\u0026plusmn;\u0026thinsp;125.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to extubation (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICU length of stay (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e26.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e62.12\u0026thinsp;\u0026plusmn;\u0026thinsp;42.50\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital length of stay (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with neurological complications (%, n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eCPB, cardiopulmonary bypass; ICU, intensive care unit;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the univariate and multivariate regression analyses, age (OR: 1.414 95%GI: 1.120\u0026ndash;1.610 p: 0.001), blood uric acid (OR: 1.925 95%GI: 1.311\u0026ndash;2.511 p: 0.001), ProBNP (OR: 1.851 95%GI: 1.325\u0026ndash;2.358 p: 0.001),NLR (OR: 1.432 95%GI: 1.121\u0026ndash;1.521 p: 0.001), CRP (OR: 1.543 95%GI: 1.321\u0026ndash;1.961 p: 0.001), the FIB-4 index (OR: 2.789 95%GI: 1.475\u0026ndash;3.124 p: 0.001), the ALBI score (OR: 2.412 95%GI: 1.784\u0026ndash;3.457 p: 0.001), the FAN score (OR: 3.614 95%GI: 2.211\u0026ndash;4.910 p: 0.001), and the HF-FAN score (OR: 4.214 95%GI: 2.984\u0026ndash;6.124 p: 0.001) were found to be independent risk factors for mortality.(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of Different Variables on Mortality in the Univariate and Multivariate Logistic Regression Analyses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e%95 CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e%95 CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLower bound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUpper bound\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eproBNP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUric acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAN score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHF-FAN score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIB-4 index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALBI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eHT: Hypertension, CRP: C-Reactive Protein, ALBI score: Albumin-Bilirubin Score\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eCut-off value: 1.63; Sensitivity 70.5%; Specificity: 68.1%\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the ROC analysis, the area under the curve (AUC) of the HF-FAN score was calculated as 0.775, the cut-off value was 1.63 with a sensitivity of 70.5% and a specificity of 68.1%. The HF-FAN score has proven to be a better prognostic indicator compared to the FAN score (AUC: 0.717), the ALBI score (AUC: 0.649), the FIB-4 index (AUC: 0.606), and NLR (AUC: 0.596). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study investigated the predictive value of the FAN score for mortality risk in patients undergoing surgery for severe aortic stenosis with preserved ejection fraction for the first time.\u003c/p\u003e \u003cp\u003eIn line with previous studies, age, blood uric acid level, CRP level, the FIB-4 index, ALBI score, and proBNP were found to be independent risk factors for mortality in our study. Aging is associated with frailty, pro-inflammatory state, increased comorbidities and immune system disorders, as well as structural and molecular changes in the heart valves, in addition to calcification and myxoid degeneration in valvular endothelial cells.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) In a prospective study, Nowicki et al. reported that aortic valve surgery mortality increased with age, with an increase of 1.96 times in patients in the age group 70 to 75 and 3.41 times in patients in the age group 80 to 95.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eUric acid is the end-product of purine metabolism. Several studies have demonstrated that pro-oxidant and pro-inflammatory effects of high serum uric acid levels can increase myeloperoxidase activity necessary for the activation of neutrophils and monocytes and interleukin (IL)-1 beta and can cause endothelial dysfunction and proliferation of smooth muscle cells. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Based on previous studies, post-myocardial infarction may be associated with heart failure as well as the severity of aortic valve disease. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Lazzeroni et al. demonstrated that mortality rates following heart valve surgery were two times higher in patients with higher serum uric acid levels compared those with a normal serum uric acid concentration. Moreover, a positive correlation was found between uric acid levels and mortality rates. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eC-reactive protein (CRP) is a key acute phase reactant, and associations exist between CRP levels and elevated blood pressure, myocardial infarction, chronic heart failure and diabetes mellitus. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) In a study conducted by Duchrowski et al., mortality rate following heart surgery was 1.64 times higher in patients with higher CRP levels.\u003c/p\u003e \u003cp\u003eNatriuretic peptid is an important biomarker of heart failure and higher preoperative or postoperative BNP levels are associated with poor prognosis in patients undergoing heart surgery. In addition, high BNP levels are associated with the need for inotropes and mechanical circulatory support. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Jiang H. et al. reported that among patients who underwent surgery for aortic stenosis with heart failure, mortality rates were 6.2 times higher in those with higher BNP levels. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe prognostic value of the FAN score that includes FIB-4 index, ALBI score and NLR has been recently recognized. FIB-4 index is a simple and non-invasive key marker of hepatic fibrosis and has a prognostic value in heart failure particularly in patients with increased right ventricular pressure. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) In a study conducted in patients undergoing transcatheter aortic valve replacement, Sudo M. et al. reported that patients with high FIB-4 index had a 1.75- fold higher risk of mortality. Furthermore, high FIB-4 index has been associated with right-sided heart failure. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) The ALBI score is a new prognostic marker and is a key indicator of liver functions in patients with hepatocellular carcinoma. The ALBI score is derived from serum albumin and bilirubin levels which are easily measured blood tests, and it is an important marker with prognostic value for liver functions and disorders. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) The ALBI score is associated with liver functions, but it also has prognostic importance in hepatocellular carcinoma, heart disease and coronavirus disease. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) In a study conducted by Duman ZM et al., a high ALBI score and acute kidney failure were found to be independent risk factors for in-hospital mortality in patients undergoing isolated or combined heart valve surgery. NLR is a marker of systemic inflammation and provides prognostic information for inflammatory processes as well as short-term and long-term prognostic information for several heart diseases including heart failure, myocardial infarction, heart valve disorders. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) Shahim B. et al. reported that a high NLR might be a prognostic indicator for mortality and re-hospitalization in patients undergoing surgery for severe aortic stenosis. Furthermore, a high NLR was found to be an independent risk factor for poor cardiac function in the long and short term. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn the literature, there are limited cardiovascular disease trials involving the FAN score. Meade et al. screened 1505 patients with heart failure between 2015 and 2020. That study aimed to investigate prognostic value of the FAN score as well as the HF score. Patients were divided into four groups based on HF-FAN scores (0, 1,2, or 3). No significant intergroup differences were found in the left ventricular ejection fraction (LVEF). Furthermore, the rates of patients with a LVEF\u0026thinsp;\u0026gt;\u0026thinsp;50% did not differ among the groups. However, the mean age, BNP levels and the diameter of the inferior vena cava were higher in the group of patients with a HF-FAN score of 3, compared to the other groups. The Receiver Operating Characteristic analysis indicated that the prognostic value of the HF-FAN score was higher than that of the original FAN score, ALBI score and NRL while AUC values for the HF-FAN score, original FAN score, ALBI score and NRL were 0.633, 0.562, 0.576 and 0.577, respectively.\u003c/p\u003e \u003cp\u003eIn line with the current literature, the original FAN score and HF-FAN score were found to be independent predictors for mortality in our study. Furthermore, the cut-off value for HF-FAN score was found to be 1.63 with a sensitivity of 70.5% and specificity of 68.1%, and the HF-FAN score was found to be a better prognostic indicator compared to the original FAN score, in line with the current literature.\u003c/p\u003e\n\u003ch3\u003eStudy Limitations\u003c/h3\u003e\n\u003cp\u003eThe main limitations of the study included its single-center design and small sample size. Right heart functions were not measured by echocardiograms and a right heart catheterization was not performed preoperatively, in study patients. Optimal medical therapies, including sacubitril/ valsartan and sodium-glucose cotransporter-2 inhibitors that have proven beneficial in heart failure, were not investigated in study patients. In addition, only preoperative scores of study patients were collected but postoperative scores were not measured.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrates that the FAN score is a simple and practical risk assessment tool for postoperative mortality in aortic stenosis with preserved ejection fraction. Moreover, this study revealed the superiority of the HF-FAN score over the original FAN core in terms of sensitivity and specificity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Declarations Ethics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee in Clinical Research (ECCR) of the First Affiliated Hospital of Giresun Medical University (Approval No. KAEK-341). In accordance with Articles 32 and 35 of the Declaration of Helsinki, written informed consent was waived for this retrospective analysis due to its minimal risk and anonymized data usage\u003c/p\u003e\n\u003cp\u003eDeclaration, the requirement for written informed consent was waived by the ECCR due to the retrospective nature of the study, which involved minimal risk to participants and preserved their anonymity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. Competing interests The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions: \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: conceptualization, data curation, writing - original draft. \u0026Ccedil;akırk\u0026ouml;se\u0026Ouml;: data curation, resources. \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: writing \u0026ndash; review \u0026amp; editing. \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: methodology. \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: resources. \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: visualization. \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: resources. \u0026ccedil;akırk\u0026ouml;se\u0026Ouml;: conceptualization, writing \u0026ndash; review \u0026amp; editing, project administration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: We didn\u0026apos;t use any artificial intelligence (AI) assisted technologies (such as Large Language Models [LLMs], chatbots, or image creators) in the production of submitted work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKodra A, Kim M. Calcific Aortic Valve Stenosis with Aging and Current Development in its Pathophysiology. Int J Angiol. 2022;31(4):229\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0042-1758382\u003c/span\u003e\u003cspan address=\"10.1055/s-0042-1758382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHita A, et al. Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making. Cardiol J. 2015;22(6):613\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5603/CJ.a2015.0034\u003c/span\u003e\u003cspan address=\"10.5603/CJ.a2015.0034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAspromonte N, Fumarulo I, Petrucci L, et al. The Liver in Heart Failure: From Biomarkers to Clinical Risk. Int J Mol Sci. 2023;24(21):15665. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms242115665\u003c/span\u003e\u003cspan address=\"10.3390/ijms242115665\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4149/BLL_2021_078\u003c/span\u003e\u003cspan address=\"10.4149/BLL_2021_078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu CC, Wu CH, Lee CH, Cheng CI. Association between neutrophil percentage-to-albumin ratio (NPAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and long-term mortality in community-dwelling adults with heart failure: evidence from US NHANES 2005\u0026ndash;2016. BMC Cardiovasc Disord. 2023;23(1):312. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12872-023-03316-6\u003c/span\u003e\u003cspan address=\"10.1186/s12872-023-03316-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamashita S, Hamamoto S, Furukawa J, et al. Prognostic impact of FAN score in patients receiving nivolumab plus ipilimumab for metastatic renal cell carcinoma. Sci Rep. 2024;14(1):12398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-024-63403-2\u003c/span\u003e\u003cspan address=\"10.1038/s41598-024-63403-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaeda D, Kanzaki Y, Sakane K. Prognostic Value of the FAN Score, a Combination of the Fibrosis-4 Index, Albumin-Bilirubin Score and Neutrophil-Lymphocyte Ratio, in Patients Hospitalized with Heart Failure. Int Heart J. 2022;63(6):1121\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1536/ihj.22-338\u003c/span\u003e\u003cspan address=\"10.1536/ihj.22-338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMembers WC, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2021;162(2):e183\u0026ndash;353.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed). 2022;75(6):524.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent E, Martin FC, Bergman H. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(19)31785-4\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(19)31785-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Vito A, Donato A, Presta I, et al. Extracellular Matrix in Calcific Aortic Valve Disease: Architecture, Dynamic and Perspectives. Int J Mol Sci. 2021;22(2):913. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms22020913\u003c/span\u003e\u003cspan address=\"10.3390/ijms22020913\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNowicki ER, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg. 2004;77(6):1966\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.athoracsur.2003.12.035\u003c/span\u003e\u003cspan address=\"10.1016/j.athoracsur.2003.12.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaito Y, Tanaka A, Node K, et al. Uric acid and cardiovascular disease: A clinical review. J Cardiol. 2021;78(1):51\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jjcc.2020.12.013\u003c/span\u003e\u003cspan address=\"10.1016/j.jjcc.2020.12.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimura Y, Tsukui D, Kono H, et al. Uric Acid in Inflammation and the Pathogenesis of Atherosclerosis. Int J Mol Sci. 2021;22(22):12394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms222212394\u003c/span\u003e\u003cspan address=\"10.3390/ijms222212394\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Lei W, Zhou J, et al. Uric acid promotes aortic valve calcification via mediating valve interstitial cell osteogenic differentiation and endothelial dysfunction. FASEB J. 2025;39(6):e70437. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1096/fj.202402831R\u003c/span\u003e\u003cspan address=\"10.1096/fj.202402831R\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazzeroni D, et al. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery. Eur J Prev Cardiol. 2018;25(2):119\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2047487317744045\u003c/span\u003e\u003cspan address=\"10.1177/2047487317744045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2017 Nov 22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fimmu.2018.00754\u003c/span\u003e\u003cspan address=\"10.3389/fimmu.2018.00754\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou HH, Tang YL, Xu TH, et al. C-reactive protein: structure, function, regulation, and role in clinical diseases. Front Immunol. 2024;15:1425168. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fimmu.2024.1425168\u003c/span\u003e\u003cspan address=\"10.3389/fimmu.2024.1425168\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCao Z, Jia Y, Zhu BBNP. NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine. nt J Mol Sci. 2019;20(8):1820. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms20081820\u003c/span\u003e\u003cspan address=\"10.3390/ijms20081820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang H, V\u0026aacute;nky F, Hultkvist H. NT-proBNP and postoperative heart failure in surgery for aortic stenosis. Open Heart. 2019;6(1):e001063. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/openhrt-2019-001063\u003c/span\u003e\u003cspan address=\"10.1136/openhrt-2019-001063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKjaergaard M, Lindvig KP, Thorhauge KH. Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease. J Hepatol. 2023;79(2):277\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhep.2023.04.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jhep.2023.04.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeo YG, Polyzos SA, Park KH, et al. Fibrosis-4 Index Predicts Long-Term All-Cause, Cardiovascular and Liver-Related Mortality in the Adult Korean Population. Clin Gastroenterol Hepatol. 2023;21(13):3322\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cgh.2023.04.026\u003c/span\u003e\u003cspan address=\"10.1016/j.cgh.2023.04.026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSudo M, Shamekhi J, Sedaghat A, et al. Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol. 2022;111(12):1367\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00392-022-02055-6\u003c/span\u003e\u003cspan address=\"10.1007/s00392-022-02055-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng M, Ng SWY, Cheung ST, et al. Clinical application of Albumin-Bilirubin (ALBI) score: The current status. Surgeon. 2020;18(3):178\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.surge.2019.09.002\u003c/span\u003e\u003cspan address=\"10.1016/j.surge.2019.09.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI Score for Predicting Hepatocellular Carcinoma Prognosis. Liver Cancer. 2020;9(6):734\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000508971\u003c/span\u003e\u003cspan address=\"10.1159/000508971\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu PJ, Feng IC, Lai CC, et al. The mortality of hospitalized patients with COVID-19 and non-cirrhotic chronic liver disease: a retrospective multi-center study. PeerJ. 2023;11:e16582. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7717/peerj.16582\u003c/span\u003e\u003cspan address=\"10.7717/peerj.16582\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsue Y, Kagiyama N, Yamaguchi T. Clinical and Prognostic Values of ALBI Score in Patients With Acute Heart Failure. Heart Lung Circ. 2020;29(9):1328\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.hlc.2019.12.003\u003c/span\u003e\u003cspan address=\"10.1016/j.hlc.2019.12.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuman ZM, Timur B, Albumin-Bilirubin Score. A Novel Mortality Predictor in Valvular Surgery. Braz J Cardiovasc Surg. 2023;38(2):271\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21470/1678-9741-2022-0008\u003c/span\u003e\u003cspan address=\"10.21470/1678-9741-2022-0008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShahim B, Redfors B, Lindman BR, et al. Neutrophil-to-Lymphocyte Ratios in Patients Undergoing Aortic Valve Replacement: The PARTNER Trials and Registries. Am Heart Assoc. 2022;11(11):e024091. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/JAHA.121.024091\u003c/span\u003e\u003cspan address=\"10.1161/JAHA.121.024091\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8280576/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8280576/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The left ventricle ejection fraction (LVEF) may be preserved or decreased in aortic stenosis (AS). Aortic stenosis may result in left ventricular diastolic dysfunction and heart failure even without a decrease in the LVEF. The heart and liver are two organs that are closely related. The FAN score which is a liver function marker that comprises the fibrosis-4 index, albumin-bilirubin score (ALBI) and neutrophil-to-lymphocyte ratio (NLR) has recently been demonstrated to have a prognostic impact in heart failure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study investigated prognostic impact of the FAN score in patients undergoing surgery for aortic stenosis with preserved ejection fraction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e After receiving approval from the Institutional Ethics Committee for this single-center, retrospective study, patients were screened to identify those who had undergone an isolated heart valve surgery for severe aortic stenosis with preserved LVEF between December 2015 and December 2024. Baseline demographics, echocardiographic, laboratory and surgical and performance status data were collected. The FAN scores and HF-FAN scores were calculated preoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 86 patients were included in the study. Study patients were divided into survivor and deceased groups based on the survival status. The survivor group included 54 (the mean age 68.8 ± 12.0 years with %51.4 males) patients and deceased group included 32 patients (the mean age 74.3 ± 12.04 years, with %53.4 males). No significant differences were found between the study groups in gender distribution, whereas patients in the deceased group were statistically significantly older. Age, uric acid, ProBNP, NLR, CRP, the FIB-4 index, ALBI score, FAN score and HF-FAN score were identified as independent risk factors for mortality in the univariate and multivariate regression analyses. Furthermore, the ROC analysis revealed that the HF-FAN score was a better prognostic indicator than the FAN score, ALBI score, FIB-4 index and NLR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study demonstrates that the FAN score is a simple and practical risk assessment tool for postoperative mortality in aortic stenosis with preserved ejection fraction\u003cem\u003e. Moreover, this study revealed the superiority of the HF-FAN score over the original FAN core, in terms of sensitivity and specificity.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Prognostic value of Heart-failure FAN score in patients with severe aortic stenosis undergoing valve replacement surgery ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 11:47:38","doi":"10.21203/rs.3.rs-8280576/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eea9bf30-a9d1-4b18-9788-133c75e2b608","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T10:40:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 11:47:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8280576","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8280576","identity":"rs-8280576","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}