Low Albumin and Elevated FIB-4 Are Associated With Adverse Outcomes After the Fontan Procedure.

Cohort studyHeart, lung & circulation· Jun 2026

Low Albumin and Elevated FIB-4 Are Associated With Adverse Outcomes After the Fontan Procedure.

Chaowapong Jarasvaraparn, Anthony J Perkins, Andrew Rodenbarger … Jean P Molleston

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Congenital Cardiac SurgeryCohort studyPrognosisQ2IF 1.8

Elevated FIB-4 score linked to markedly higher risk of adverse Fontan outcomes

Low Albumin and Elevated FIB-4 Are Associated With Adverse Outcomes After the Fontan Procedure.

Chaowapong Jarasvaraparn … Jean P Molleston

Heart, lung & circulation · Jun 2026 · Q2 in Respiratory Medicine

Background

Fontan-associated liver disease contributes to long-term morbidity and mortality.

Purpose

This study evaluated whether non-invasive liver fibrosis scores-aspartate transaminase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) and routine clinical hepatic synthetic function, specifically albumin-predict adverse outcomes when obtained 10 and 20 years after the Fontan procedure.

Methods

We conducted a retrospective analysis of Fontan patients with laboratory data available at ≥10 years post-procedure.

n = 98 patients

HR 21.3

Results

HR 21.3

risk of death, transplant, or Fontan failure rises sharply with high FIB-4

n = 98 patients

More results

At least one adverse outcome occurred in 8% (8/98) of patients at 10 years and 12% (13/109) of patients at 20 years.

Albumin <3.5 g/dL was associated with adverse outcomes at both 10 years (hazard ratio [HR] 8.54; p=0.02) and 20 years (HR 4.31; p=0.03).

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Conclusion · 1 of 2

Low albumin and elevated FIB-4 scores, usually leveraged in evaluation of liver disease, are associated with more frequent adverse outcomes of death, heart transplantation, or Fontan failure.

Conclusion · 2 of 2

These markers may serve as simple, non-invasive prognostic tools in long-term follow-up.

Low Albumin and Elevated FIB-4 Are Associated With Adverse Outcomes After the Fontan Procedure.

Low Albumin and Elevated FIB-4 Are Associated With Adverse Outcomes After the Fontan Procedure.

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