{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T20:39:02Z","timestamp":1779223142564,"version":"3.51.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To evaluate how well liver fibrosis markers (fibrosis-4 index, aspartate aminotransferase to platelet ratio index, and model for end-stage liver disease excluding international normalized ratio score) can predict early detection of Fontan-associated liver disease and to identify risk factors for Fontan-associated liver disease development.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>This retrospective multicentre study included patients who underwent the Fontan procedure between 2004 and 2020 with at least 3\u2009years of follow-up. Blood tests and imaging were conducted to diagnose Fontan-associated liver disease. The predictive value of these markers was assessed using receiver operating characteristic curve analysis. Risk factors for Fontan-associated liver disease development were identified using Fine\u2013Gray subdistribution hazard analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>This study included 137 patients. The fibrosis-4 index, measured at 2\u2009years post-Fontan, was a strong predictor for Fontan-associated liver disease development 10\u2009years later (area under the curve: 0.81, optimal cutoff value: 0.17, 83.1% sensitivity, and 73.0% specificity). Fine\u2013Gray subdistribution hazard analysis shows that a fibrosis-4 index level was a key risk factor for Fontan-associated liver disease. Patients with a fibrosis-4 index &amp;gt;0.17 after 2\u2009years had a higher incidence of Fontan-associated liver disease after 10\u2009years (45.6%) than patients with fibrosis-4 index \u22640.17 (3.9%, P\u2009=\u20090.002). These patients also had higher pulmonary artery pressure 5\u2009years later.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The fibrosis-4 may be a useful marker for early detection of Fontan-associated liver disease, which, in this study, was identified as a risk factor for the disease\u2019s development.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CLINICAL REGISTRATION NUMBER<\/jats:title>\n                  <jats:p>Kitasato University, No. B23-130; 7 February 2024.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf100","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T13:45:17Z","timestamp":1743255917000},"source":"Crossref","is-referenced-by-count":3,"title":["Liver fibrosis marker is a potential predictor of the development of Fontan-associated liver diseases"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8402-0867","authenticated-orcid":false,"given":"Sakura","family":"Horie","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Kitasato University School of Medicine , Kanagawa,","place":["Japan"]},{"name":"Department of Cardiac Surgery, The University of Tokyo Hospital , Tokyo,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumiaki","family":"Shikata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Kitasato University School of Medicine , Kanagawa,","place":["Japan"]},{"name":"Department of Cardiac Surgery, The University of Tokyo Hospital , Tokyo,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norihiko","family":"Oka","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Cardiovascular Surgery, Jichi Children\u2019s Medical Center , Tochigi,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Okamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gunma Children\u2019s Medical Center , Gunma,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshikiyo","family":"Matsunaga","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gunma Children\u2019s Medical Center , Gunma,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenta","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gunma Children\u2019s Medical Center , Gunma,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsutomu","family":"Hataoka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gunma Children\u2019s Medical Center , Gunma,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0552-2727","authenticated-orcid":false,"given":"Tadashi","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Kitasato University School of Medicine , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaomi","family":"Fukuzumi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Kitasato University School of Medicine , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryoichi","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Kitasato University School of Medicine , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichiro","family":"Hirata","sequence":"additional","affiliation":[{"name":"Department 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