Evaluation of the risk of hepatic fibrosis in the preoperative period of bariatric surgery using the Fibrosis-4 score (FIB-4): A retrospective observational analysis
DOI:
https://doi.org/10.33448/rsd-v14i11.49985Keywords:
Hepatic fibrosis, FIB-4, Nonalcoholic fatty liver disease, Bariatric surgery, Obesity.Abstract
Introduction: Hepatic fibrosis is a common complication in individuals with obesity and nonalcoholic fatty liver disease (NAFLD), increasing the risk of morbidity and mortality in bariatric surgery. The FIB-4 index, based on simple laboratory parameters, has been proposed as a noninvasive tool to estimate the degree of fibrosis. Objective: To evaluate the performance of the FIB-4 score in predicting hepatic fibrosis in candidates for bariatric surgery with hepatic steatosis. Methods: Retrospective observational study (2015–2023) including 618 patients aged ≥18 years with confirmed steatosis and preoperative laboratory tests. The FIB-4 was calculated and compared with histopathological examination (gold standard). Analyses included multivariable logistic regression and ROC curve. Results: The cohort had a mean age of 38.9 ± 10.2 years and a predominance of females (75.2%). A FIB-4 cutoff ≥ 1.3 was significantly associated with histological fibrosis (OR 21.87; 95%CI 10.92–43.79; p<0.001). After multivariable adjustment, FIB-4 maintained an independent association (OR 8.79; 95%CI 4.19–18.45; p<0.001). The AUC was 0.744 (95%CI 0.658–0.830), with specificity of 95.4%, sensitivity of 51.1%, and negative predictive value of 96%. Conclusion: FIB-4 demonstrated good discriminative ability and high specificity for excluding significant hepatic fibrosis in bariatric patients. Its preoperative application may optimize low-cost screening and reduce invasive procedures, although positive results should be confirmed by complementary methods.
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Copyright (c) 2025 Jose Daniel Mera Rivas, Cindy Estephania Franco Cedeño, Nathali Eureka Bencosme Veras, Juan Miguel Machare Torres, Frederico Japiassu Santiago, Gabrielle Vaz de Azevedo David, Guilherme Lemos Cotta Pereira
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