Prognostic value of liver fibrosis-4 index in acute ischemic stroke after reperfusion treatment: A meta-analysis

Objectives: Reperfusion therapy has enhanced clinical outcomes in acute ischemic stroke (AIS), yet variability in patient prognosis persists. Recent evidence indicates that the fibrosis-4 (FIB-4) index, which assesses the degree of liver fibrosis, has potential as a prognostic biomarker in patients with AIS. We evaluate whether the FIB-4 index can predict clinical outcomes in AIS patients treated with reperfusion therapy, focusing on poor functional outcome (3-month mRS score ≥3), symptomatic intracranial hemorrhage (sICH), and 3-month mortality. Materials and Methods: We systematically searched PubMed, Scopus, and Web of Science up to May 2025 to identify eligible studies. Included were observational studies examining the relationship between the FIB-4 index and clinical outcomes in patients with AIS undergoing reperfusion therapy. Analyses were performed with Review Manager software. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were combined using fixed-or random-effects models as appropriate. Results: Eleven cohort studies, totalling 7.216 patients, were included. A higher FIB-4 index was significantly associated with increased risks of poor 3-month outcomes (odds ratio [OR] = 1.72, 95% CI: 1.51–1.96), sICH (OR = 1.35, 95% CI: 1.21–1.50), and mortality at 3 months (OR = 1.82, 95% CI: 1.15–2.87). Heterogeneity was moderate to high in analyses of 3-month mortality. Overall, the FIB-4 index emerges as a new prognostic biomarker for unfavourable outcomes. Conclusion: A high FIB-4 index is associated with an increased risk of poor 3-month, sICH, and 3-month mortality.