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
Chang et al. (Fri,) studied this question.