Mortality Risk Associated with Liver Fibrosis in Patients Undergoing Abdominal Aortic Aneurysm Repair Surgery: A Longitudinal Study

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 correlation between FIB-4 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 duration of 35 months of follow up (IQR: 0.7–56.6).All-cause mortality was the primary outcome. Hazard ratios (HR) 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, the HR for patients with a baseline FIB-4 ≥ 2.67 was 1.78 (95% CI: 1.06–3.00). Furthermore, FIB-4 ≥ 2.67 was significantly associated with a baseline aneurysm size ≥ 8cm [OR = 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.