ABSTRACT NUMBER: ESOC2026A1297 FIB-4 PREDICTS POOR FUNCTIONAL OUTCOMES AND HEMORRHAGIC RISK AFTER ENDOVASCULAR THROMBECTOMY: ANALYSIS OF THE NATIONWIDE TREAT-AIS REGISTRY

Abstract Background and aims The fibrosis-4 (FIB-4) index is a noninvasive marker of liver fibrosis associated with adverse ischemic stroke outcomes, but its role in patients undergoing endovascular thrombectomy (EVT) remains unclear. We investigated the association between FIB-4 and post-EVT outcomes using a nationwide multicenter registry. Methods Anterior-circulation EVT cases from the Taiwan TREAT-AIS registry (2019–2025) were analyzed. Patients were stratified into FIB-4 quartiles (Q1–Q4). Outcomes included 3-month functional status, symptomatic intracranial hemorrhage (sICH), mortality, successful recanalization, and early NIHSS change. Multivariable logistic regression adjusted for demographic, clinical, and procedural confounders. A TREAT-AIS-FIB Composite Score was developed by incorporating the optimal FIB-4 cutoff (1.619) into the original TREAT-AIS score. Results Among 1,816 patients, higher FIB-4 quartiles were associated with older age, higher baseline NIHSS, and more atrial fibrillation. Compared with Q1, Q4 was associated with lower odds of good functional outcome (adjusted odds ratio [aOR] 0.61; 95% CI 0.37–0.98). Higher FIB-4 quartiles were independently associated with sICH (Q2 aOR 2.94; Q3 aOR 3.10; Q4 aOR 4.26) and mortality, with the highest risk observed in Q4 (aOR 5.24; 95% CI 2.86–9.61). Incorporating FIB-4 significantly improved sICH prediction, increasing the AUC by 0.030 (p = 0.016). Conclusions Elevated FIB-4 independently predicts poorer functional recovery, higher sICH risk, and increased mortality after EVT. The TREAT-AIS-FIB Composite Score improves hemorrhagic risk stratification and may inform post-EVT clinical decision-making. Conflict of interest Yu-Ming Chang: nothing to disclose