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

BACKGROUND/AIMS: 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.

MATERIALS AND

METHODS

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.

RESULTS

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).

CONCLUSION

A high FIB-4 score may serve as a predictive marker for postoperative complications in patients with MASLD undergoing surgery. Cite this article as: Eren F, Goktug MR, Ari D, et al. Fibrosis-4 score and postoperative outcomes in metabolic dysfunction-associated steatotic liver disease. Turk J Gastroenterol. 2026;37(1):127-135.