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.