Fibrosis-4 Score and Postoperative Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease

TL;DR

The study shows that a high Fibrosis-4 score in patients with liver disease is linked to more post-surgery complications.

Contribution

This study is the first to show that the FIB-4 score can predict postoperative complications in MASLD patients.

Findings

Patients with higher FIB-4 scores had significantly more postoperative complications.

12-month mortality was higher in patients with high FIB-4 scores, though not statistically significant.

Abstract

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally. The Fibrosis-4 (FIB-4) score is a noninvasive biomarker used for assessing potential advanced fibrosis. The study aimed to evaluate the role of the FIB-4 score in predicting postoperative complications and mortality in patients undergoing surgery.

This multicenter retrospective study included 11 072 patients who underwent surgery under general anesthesia. Demographic and clinical data—including age, gender, comorbidities, FIB-4 scores, American Society of Anesthesiologists classification, postoperative complications, and mortality—were analyzed.

A total of 1667 MASLD patients were included. Patients were classified based on FIB-4 scores: 70% (n = 1167) had FIB-4 < 1.30, 25.1% (n = 418) had 1.30 < FIB-4 ≤ 2.67, and 4.9% (n = 82) had FIB-4 ≥ 2.67. Due to the limited number of patients with possible advanced fibrosis (FIB-4 ≥ 2.67), propensity score (PS) matching was performed. After PS matching, patients with a high FIB-4 score exhibited a significantly higher rate of postoperative complications (P < .001), and 12-month mortality was elevated (11%), although the difference was not statistically significant (P = .481).

A high FIB-4 score may serve as a predictive marker for postoperative complications in patients with MASLD undergoing surgery.

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