Association of Liver Fibrosis Fibrosis-4 Score with Perioperative Complications and Mortality: A Retrospective...

Metabolic dysfunction-associated steatotic liver disease (MASLD) and related advanced fibrosis are associated with poor hepatic and extrahepatic outcomes. However, the role of liver fibrosis in surgery-related mortality remains unclear. The authors aimed to assess the association between a widely used liver fibrosis marker, the Fibrosis-4 (FIB-4) score, and 30-day postoperative mortality and complications.

A multicenter historical cohort of patients underwent general anesthesia. Data were obtained from the Multicenter Perioperative Outcomes Group dataset. Exclusion criteria included known liver diseases other than MASLD, hepatic failure, and alcohol use disorder. Risk of liver fibrosis was calculated using the FIB-4 score and categorized using the MASLD accepted predefined ranges. Mixed-effects multivariable logistic regression models were built to assess the adjusted conditional odds ratio (cOR) for the primary outcome of mortality and secondary outcomes of acute kidney injury, myocardial injury, and postoperative pulmonary complications.

The final cohort size for the primary outcome of mortality was 1,325,102. Compared to the low-risk FIB-4 category (1.3 or less), the inconclusive FIB-4 category (1.3 to 2.67) was associated with an adjusted cOR of 1.533-fold for mortality (99.75% CI, 1.453 to 1.616), while the elevated category (FIB-4, 2.67 or greater) was associated with an adjusted cOR of 3.765-fold (99.75% CI, 3.572 to 3.969). This association persisted with the application of age-adjusted FIB-4 cutoffs in stratification by age category. A dose-response association was also observed between FIB-4 as a continuous variable and mortality. Among secondary outcomes, elevated FIB-4 was associated with a postoperative cOR of 1.515 for acute kidney injury (99.75% CI, 1.435 to 1.598), a cOR of 1.657 for myocardial injury (99.75% CI, 1.401 to 1.960), and a cOR of 1.323 for postoperative pulmonary complications (99.75% CI, 1.280 to 1.369).

The FIB-4 score is associated with postoperative mortality and complications in a population without clinically apparent liver disease, and evaluation may have value in preoperative patient counseling and optimization.