An elevated Fibrosis-4 score is associated with poor clinical outcomes in patients with sepsis: an observational cohort study

Abstract

Introduction: So far, no study has investigated the association between subclinical hepatic fibrosis and sepsis, especially in terms of prognosis.

Objectives: The purpose of our study was to explore the association of liver fibrosis indexes with the outcomes of septic patients without overt chronic liver disease.

Patients and methods: We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care III (version 1.4) database. External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We calculated the Aspartate Aminotransferase-to-Platelet Ratio Index, the Fibrosis‑4 (FIB‑4) score, and the Nonalcoholic Fatty Liver Disease Fibrosis Score using the existing formulas. The primary outcome was 28‑day mortality. We assessed the associations of these 3 indexes with patient outcomes using logistic regression analysis.

Results: In the FIB‑4 sepsis cohort (n = 1560), there was a significant stepwise increase from quartile 1 to quartile 4 in the risk of 28‑day mortality (quartile 1: reference; quartile 2: odds ratio [OR], 1.57, P = 0.06, 95% CI, 0.98-2.515; quartile 3: OR, 2.363, P <0.001, 95% CI, 1.512-3.692; quartile 4: OR, 2.933, P <0.001, 95% CI, 1.895-4.538). The results of multivariable regression, Kaplan-Meier, and Cox regression analyses as well as external validation exhibited good consistency.

Conclusions: The FIB‑4 index is associated with 28‑day, 90‑day, and in‑hospital mortality as well as with renal replacement therapy in septic patients without overt chronic liver disease. In other words, an advanced stage of subclinical hepatic fibrosis as represented by the FIB‑4 score indicates poor outcomes in patients with sepsis.