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

Abstract

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.