Predictive Value of Liver Fibrosis Index-4 for Clinical Outcomes Following Carotid Artery Stenting

This study aims to evaluate the predictive value of the fibrosis-4 (FIB-4) index, a noninvasive measure of liver fibrosis, for in-hospital and 5-year outcomes in patients undergoing carotid artery stenting (CAS).

A retrospective cohort study of 598 patients undergoing CAS were categorized into three groups based on their FIB-4 indices: low (<1.3, n = 233), intermediate (1.3-2.67, n = 303), and high (>2.67, n = 62). In-hospital and long-term outcomes were compared between the groups. Assessment of prognostic performance was conducted using multivariable Cox models and receiver operating characteristic (ROC) analysis.

In-hospital rates of ipsilateral and major strokes, myocardial infarction, death, and major adverse cardiovascular events (MACE) were significantly increased in patients with high index compared to those with intermediate and low indices (3.9% vs. 5.6% vs. 14.5%, P = 0.006; 2.1% vs. 14.9% vs. 24.2%, P < 0.001; 0% vs. 3% vs. 4.8%; P = 0.013; 1.3% vs. 5.6% vs. 16.1%, P < 0.001; 4.3% vs. 13.9% vs. 29%, P < 0.001, respectively). At 5 years of follow-up, rates of ipsilateral and major strokes, transient ischemic attack, death, and MACE were significantly different between the groups (6.7% vs. 11.4% vs. 20%, P = 0.008; 8.8% vs. 9.4% vs. 16.7%, P = 0.025; 3.6% vs. 4.7% vs. 11.7%; P = 0.035, 4.9% vs. 16.7% vs. 26.7%, P < 0.001; 10.7% vs. 21.7% vs. 28.3%, P < 0.001, respectively). FIB-4 indices >1.8 and >1.57 predicted in-hospital major stroke and mortality with areas under the ROC curves of 0.751 and 0.739, respectively (P < 0.001 for all) CONCLUSION: Higher FIB-4 index may serve as a surrogate marker of carotid artery stenosis, extending its prognostic relevance beyond hepatic fibrosis and may also predict increased risk of in-hospital and 5-year stroke and mortality in patients undergoing CAS.