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. 2025 Jan 26;15(1):3301.
doi: 10.1038/s41598-025-88133-x.

Association of liver fibrosis with aneurysm size and mortality risk in patients undergoing open abdominal aortic aneurysm repair

Mohamad Jamalinia #  1 , Seyed Alireza Mirhosseini #  2   3 , Maryam Ranjbar  1   3 , Kamran Bagheri Lankarani  4 , Ahmad Hosseinzadeh  5
Affiliations

Association of liver fibrosis with aneurysm size and mortality risk in patients undergoing open abdominal aortic aneurysm repair

Mohamad Jamalinia et al. Sci Rep. .

Abstract

Abdominal Aortic Aneurysm (AAA) poses a significant health risk due to its silent nature and high mortality upon rupture. The Fib-4 index, initially designed for liver fibrosis assessment, presents potential beyond its scope. This study aims to investigate the association of FIB-4 with aneurysm size and mortality risk, exploring its utility as a risk predictor for enhanced clinical management. This retrospective longitudinal research studied 141 AAA open repair surgery patients (92% male, mean age of 70 years (SD: 11.5)) from October 2016 to September 2021 for a median follow-up 35 months (IQR: 0.7 - 56.6). All-cause mortality was the primary outcome. Adjusted hazard ratios (aHR) were calculated for each Fib-4 cut-off between 1.5 and 3.25. FIB-4 cut-off range of 2.58-2.74 was associated with higher mortality risk in adjusted HR. Specifically, FIB-4 ≥ 2.67 increased mortality by 78% (aHR:1.78, 95% CI: 1.06 - 3.00). Furthermore, FIB-4 ≥ 2.67 was significantly associated with a baseline aneurysm size ≥ 8cm (aOR: 2.67, 95% CI: 1.17 - 6.09). FIB-4 was independently associated with a higher mortality risk and higher aneurysm size. These findings suggest that FIB-4 assessment in clinical practice may enhance risk profiling, aiding in more precise stratification and management strategies for AAA patients.

Keywords: Abdominal aortic aneurysm; Cardiovascular disease; Liver fibrosis; Risk stratification.

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Conflict of interest statement

Declartions. Competing interests: The authors declare no competing interests. Ethics approval: This study was approved by the ethics committee of Shiraz University of Medical Sciences under reference number IR.SUMS.MED.REC.1402.446 adhered to the ethical standards outlined by institutional and national research committees, following the principles of the 1964 Helsinki Declaration and its subsequent amendments or equivalent ethical standards. Prior to enrollment, all participants provided written informed consent. Informed consent: Written informed consent was obtained from all individual participants included in the study. The purpose of the research was thoroughly explained to the patients, and they were assured that their information would be kept confidential by the researcher.

Figures

Fig. 1
Fig. 1
Flowchart of study exclusion criteria and patient inclusion.
Fig. 2
Fig. 2
illustrates the relationship between Fib-4 cut-off values and hazard ratios. The x-axis displays each Fib-4 cut-off value, while the y-axis represents the corresponding hazard ratio. Confidence intervals around each Fib-4 cut-off are depicted to provide a measure of uncertainty. The first plot depicts unadjusted hazard ratios, while the second plot presents fully adjusted hazard ratios.
Fig. 3
Fig. 3
illustrates Kaplan–Meier plots depicting cumulative survival and hazards stratified by Fib-4 levels (≥ 2.67).
See this image and copyright information in PMC

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