Association of liver fibrosis−4 index with functional outcomes in chinese patients with acute ischemic stroke undergoing mechanical thrombectomy

This study aimed to investigate the association between the Fibrosis-4 (FIB-4) index and functional outcomes and hemorrhagic complications in patients with large vessel occlusion acute ischemic stroke (LVO-AIS) treated with mechanical thrombectomy (MT). In this single-center retrospective cohort study, we consecutively enrolled patients with LVO-AIS who underwent MT between January 2018 and February 2024. The primary endpoint was poor functional outcome at 90 days (modified Rankin Scale score 3-6). Secondary endpoints included hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH). Multivariable logistic regression models and restricted cubic spline analyses were used to evaluate the association between FIB-4 index and outcomes after adjusting for potential confounders. Among 421 patients, 254 (60.33%) had poor outcomes, 197 (46.79%) developed HT, and 76 (18.05%) experienced sICH. After adjustment for confounding factors, each unit increase in FIB-4 index was associated with a 38% higher risk of poor outcome (P = 0.013). This association showed significant nonlinearity (P-nonlinear = 0.010), with risk increasing exponentially beyond a FIB-4 threshold of 2.4. Advanced fibrosis (FIB-4 ≥ 2.67) was independently associated with poor outcomes (P = 0.024). FIB-4 index independently predicts poor functional outcomes in LVO-AIS patients. This readily available biomarker may help identify high-risk patients who could benefit from enhanced monitoring and individualized treatment strategies.