Preprocedural Fibrosis-4 Index Is Independently Associated with Previous Cerebrovascular Events in Patients Undergoing Carotid Artery Stenting

Abstract

ObjectiveThe Fibrosis-4 (FIB-4) index is a simple, non-invasive marker originally developed to estimate hepatic fibrosis and has recently emerged as a potential indicator of systemic inflammation and atherosclerosis. This study investigated the association between the preprocedural FIB-4 index and previous cerebrovascular events in patients undergoing carotid artery stenting (CAS).Materials and MethodsThis retrospective observational study included 221 consecutive patients who underwent CAS for significant carotid artery stenosis. Patients were categorized according to the presence or absence of previous cerebrovascular events. Demographic, clinical, and laboratory characteristics were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of previous cerebrovascular events. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of the FIB-4 index, and the optimal cut-off value was determined using the Youden index, based on the best balance between sensitivity and specificity.ResultsAmong the 221 patients, 133 (60.2%) had a history of previous cerebrovascular events. Compared with patients without previous cerebrovascular events, those with previous cerebrovascular events had significantly lower platelet counts and HDL cholesterol levels and significantly higher fasting glucose and FIB-4 index values (all p < 0.05). In multivariable logistic regression analysis, chronic kidney disease (OR: 3.06, 95% CI: 1.46–6.39, p = 0.003), lower HDL cholesterol (OR: 0.96 per 1 mg/dL increase, 95% CI: 0.93–0.99, p = 0.011), and a higher FIB-4 index (OR: 2.19 per 1-unit increase 95% CI: 1.29–3.73, p = 0.004) were independently associated with previous cerebrovascular events. ROC analysis demonstrated modest discriminatory performance of the FIB-4 index (AUC: 0.611, 95% CI: 0.535–0.687, p = 0.005). A FIB-4 value of 1.54 yielded a sensitivity of 51.1% and a specificity of 64.8% for identifying patients with previous cerebrovascular events.ConclusionAn elevated preprocedural FIB-4 index was independently associated with previous cerebrovascular events in patients undergoing carotid artery stenting. Although its discriminatory performance was modest, the FIB-4 index may serve as an inexpensive and readily available biomarker that may provide complementary information regarding systemic vascular risk. Larger prospective multicenter studies are warranted to validate this association and determine the potential clinical utility of FIB-4 in this population.