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FIB-4 index associated with mortality risk of patients with systemic lupus erythematosus: a large retrospective
Ziyi Jin1, Xuebing Feng1, Dandan Wang1
1Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Insights
The Fibrosis-4 (FIB-4) index is linked to higher mortality in Systemic Lupus Erythematosus (SLE) patients. This study reveals a nonlinear association, suggesting FIB-4 as a potential independent prognostic indicator for SLE.
Area of Science:
- Hepatology
- Rheumatology
- Clinical Epidemiology
Background:
- Systemic Lupus Erythematosus (SLE) frequently presents with liver enzyme abnormalities.
- The prognostic value of the Fibrosis-4 (FIB-4) index in SLE patients remains underexplored.
Purpose of the Study:
- To investigate the association between the FIB-4 index and overall mortality in SLE patients.
- To explore the dose-response relationship and potential nonlinear associations between FIB-4 and SLE mortality.
Main Methods:
- A multicenter retrospective cohort study of 2331 first-admission SLE patients (1999-2009).
- FIB-4 index calculated using age, platelet count (PLT), ALT, and AST.
- Cox and restricted cubic spline (RCS) models used to assess mortality risk (HR, 95% CI).
Main Results:
- Over 15 years, 226 deaths occurred in 2331 SLE patients.
- Elevated FIB-4 (≥1.92), PLT, ALT, and AST were associated with increased mortality (adjusted HRs ranging from 1.54 to 1.88).
- Significant nonlinear dose-response relationships observed between mortality and PLT, ALT, and FIB-4 index.
Conclusions:
- The FIB-4 index demonstrates a nonlinear association with increased mortality in SLE patients.
- FIB-4 may serve as an independent prognostic biomarker for SLE patients.
- High FIB-4 was linked to liver failure deaths and indirectly to deaths from infection and neuropsychiatric causes.
Introduction:
A considerable proportion of patients with systemic lupus erythematosus (SLE) have liver enzyme abnormalities. We evaluated whether fibrosis-4 (FIB-4) was associated with increased mortality of SLE patients.
Material And Methods:
A multicenter retrospective cohort study was conducted based on medical records of first-admission SLE patients who were hospitalized during 1999-2009 in Jiangsu province. FIB-4 was estimated by age, platelet (PLT) count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and FIB-4. A Cox model and a restricted cubic spline (RCS) model were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI).
Results:
During up to 15 years of follow-up, 226 deaths were observed among 2331 SLE patients. Increased overall mortality was associated with abnormal groups of PLT, ALT, AST, and high FIB-4 (≥ 1.92), with adjusted HRs (95% CI) of 1.58 (1.19-2.11), 1.54 (1.14-2.07), 1.58 (1.17-2.12), and 1.88 (1.42-2.50), respectively. Moreover, significant dose-response relationships were found between mortality of SLE and those indexes, and it was nonlinear for PLT (p < 0.001), ALT (p = 0.046) and FIB-4 (p < 0.001), but not AST (p = 0.109). In cause-specific analyses, high FIB-4 index was directly associated with death from liver failure and indirectly associated with other death from infection and neuropsychiatric impairment. We found no significant differences of areas under curves (AUCs) between FIB-4 index and the disease activity index score of SLE.
Conclusions:
This is the first report to describe the nonlinear association between FIB-4 index and increased mortality of SLE patients. The FIB-4 index may be used as an independent prognostic indicator for SLE patients.
