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Background <p>Metabolic hepatokines and liver fibrosis are increasingly recognized as mediators of cardiometabolic risk; however, their prognostic relevance in hospitalized hyperglycemic patients remains inadequately defined. This study evaluated the association of fibroblast growth factor-21 (FGF-21), Fetuin-A, non-invasive liver fibrosis scores, and sarcopenic obesity with adverse in-hospital outcomes.</p> Methods <p>In this prospective observational study, 362 consecutive adults admitted with hyperglycemia were enrolled. Serum FGF-21 and Fetuin-A concentrations were quantified using enzyme-linked immunosorbent assay. Body composition was assessed via bioelectrical impedance analysis to define sarcopenia and sarcopenic obesity. Hepatic fibrosis was evaluated using FIB-4, APRI, and transient elastography (FibroScan). The primary composite outcome included in-hospital infection, acute kidney injury (AKI), intensive care unit (ICU) admission, hyperglycemic crises, prolonged hospitalization, and mortality. Multivariate logistic regression identified independent predictors of adverse outcomes. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis.</p> Results <p>Sarcopenic obesity was present in 62 (17.1%) patients and was significantly associated with higher rates of adverse outcomes compared with patients without sarcopenic obesity (<i>n</i> = 300), including infection (24 [38.7%] vs. 72 [24.0%]), acute kidney injury (16 [25.8%] vs. 38 [12.7%]), ICU admission (11 [17.7%] vs. 28 [9.3%]), and mortality (6 [9.7%] vs. 8 [2.7%]) (all <i>p</i> &lt; 0.05). Elevated FGF-21 levels and higher fibrosis scores correlated strongly with adverse events. Independent predictors of poor in-hospital outcomes included HbA1c ≥ 8.5%, severe hyperglycemia at admission, sarcopenic obesity, and elevated FGF-21 levels (all <i>p</i> &lt; 0.05). A combined predictive model incorporating clinical and biomarker variables demonstrated robust discrimination (AUC 0.84), with 82% sensitivity and 90% negative predictive value (NPV).</p> Conclusion <p>FGF-21, sarcopenic obesity, and non-invasive liver fibrosis markers independently predict adverse in-hospital outcomes among hyperglycemic patients. Integrating hepatokine profiling and body composition assessment into inpatient risk stratification models may improve early identification of high-risk individuals.</p>

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Association of FGF-21, Fetuin-A, Liver Fibrosis Scores, Sarcopenic Obesity and In-Hospital Outcomes in Hyperglycemic Inpatients: A Prospective Observational Study

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • Surender,
  • Vyas M. Shingatgeri,
  • Pushpender Khatana,
  • Mohd Zeeshan Nazm,
  • Sunil Kumar Mishra,
  • Mohammad Shafi Kuchay

摘要

Background

Metabolic hepatokines and liver fibrosis are increasingly recognized as mediators of cardiometabolic risk; however, their prognostic relevance in hospitalized hyperglycemic patients remains inadequately defined. This study evaluated the association of fibroblast growth factor-21 (FGF-21), Fetuin-A, non-invasive liver fibrosis scores, and sarcopenic obesity with adverse in-hospital outcomes.

Methods

In this prospective observational study, 362 consecutive adults admitted with hyperglycemia were enrolled. Serum FGF-21 and Fetuin-A concentrations were quantified using enzyme-linked immunosorbent assay. Body composition was assessed via bioelectrical impedance analysis to define sarcopenia and sarcopenic obesity. Hepatic fibrosis was evaluated using FIB-4, APRI, and transient elastography (FibroScan). The primary composite outcome included in-hospital infection, acute kidney injury (AKI), intensive care unit (ICU) admission, hyperglycemic crises, prolonged hospitalization, and mortality. Multivariate logistic regression identified independent predictors of adverse outcomes. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis.

Results

Sarcopenic obesity was present in 62 (17.1%) patients and was significantly associated with higher rates of adverse outcomes compared with patients without sarcopenic obesity (n = 300), including infection (24 [38.7%] vs. 72 [24.0%]), acute kidney injury (16 [25.8%] vs. 38 [12.7%]), ICU admission (11 [17.7%] vs. 28 [9.3%]), and mortality (6 [9.7%] vs. 8 [2.7%]) (all p < 0.05). Elevated FGF-21 levels and higher fibrosis scores correlated strongly with adverse events. Independent predictors of poor in-hospital outcomes included HbA1c ≥ 8.5%, severe hyperglycemia at admission, sarcopenic obesity, and elevated FGF-21 levels (all p < 0.05). A combined predictive model incorporating clinical and biomarker variables demonstrated robust discrimination (AUC 0.84), with 82% sensitivity and 90% negative predictive value (NPV).

Conclusion

FGF-21, sarcopenic obesity, and non-invasive liver fibrosis markers independently predict adverse in-hospital outcomes among hyperglycemic patients. Integrating hepatokine profiling and body composition assessment into inpatient risk stratification models may improve early identification of high-risk individuals.