In people without apparent liver illness, a simple hepatic fibrosis test is highly related to perioperative mortality and may help with future surgical risk assessment and preoperative optimization. The aim of this study was to assess whether fibrosis-4 (FIB-4), that consists of age,  alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelets, a validated marker of hepatic fibrosis, is linked with postoperative mortality in the general surgical population.

A historical cohort of people who underwent general anaesthesia were examined. Alcohol use disorder, acute liver disease or hepatic failure, and known liver disease were the exclusion criteria. The FIB-4 score was graded into three validated predefined categories. A FIB-4 score of ≤1.3 was used to rule out advanced fibrosis, >1.3 and <2.67 was used to indicate inconclusiveness, and ≥2.67 was used to depict advanced fibrosis.

Propensity score matching was the key analytical technique. FIB-4 was dichotomized to show advanced fibrosis. Multivariable logistic regression was utilized as a secondary analysis. Notably, 1995 (10%) of the 19,861 incorporated volunteers exhibited advanced fibrosis according to the FIB-4 criteria. In total, 15 volunteers  (0.1%) died during surgery, 272 volunteers (1.4%) died while in the hospital, and 417 patients (2.1%) died within 30 days of the procedure. After correcting for other risk variables, FIB-4 ≥2.67 was linked to higher intraoperative mortality (odds ratio [OR], 3.63), hospital mortality (OR, 3.14), and mortality within 30 days of surgery (OR, 2.46).

For the three FIB-4 categories of ≤1.3 (reference), >1.3 and  <2.67, and ≥2.67 respectively, FIB-4 was connected to greater mortality in a dose-dependent way; during hospitalization (OR, 1.89 and OR, 4.70), and within 30 days from surgery  (OR, 1.77 and OR, 3.55). The disparities in mortality persisted in a sample with a 1:1 propensity match (N = 1994 for each group). Mortality during hospitalization was 5.1% vs. 2.2% (OR, 2.70) comparing the FIB-4 ≥2.67 groups vs the FIB-4 <2.67 groups, and 30-day mortality was 6.6% vs. 3.4%. (OR, 2.26).

Hence, preoperative FIB-4 score ≥2.67 (defined as the threshold for advanced fibrosis) was linked with raised risk of intraoperative mortality, mortality during hospitalization, and 30-day mortality.