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Peer-reviewedCC BY-NC 4.0Annals of Gastroenterological Surgery

Preoperative FIB‐4 Index as a Potential Factor Associated With Severe Postoperative Complications and Endogenous Organ Failure After Hepatectomy for Hepatocellular Carcinoma

  • Masanori Nakamura1,2
  • Yukiyasu Okamura1
  • Osamu Aramaki1
  • Nao Yoshida1
  • Yusuke Mitsuka1
  • Hayato Abe1
  • Shunsuke Yamagishi1
  • Yasuhiro Okumura1
  • Kyongsun Pak3
  • Shinobu Masuda4
4 affiliations
  1. 1Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine Tokyo Japan
  2. 2Department of Gastroenterological Surgery Nagoya University Graduate School of Medicine Nagoya Japan
  3. 3Division of Biostatistics, Department of Data Management, Center for Clinical Research National Center for Child Health and Development Tokyo Japan
  4. 4Division of Human Pathology, Department of Pathology and Microbiology Nihon University School of Medicine Tokyo Japan
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Abstract

Background: Liver fibrosis influences tolerance to surgical stress, dictating postoperative complication risks after hepatectomy for hepatocellular carcinoma (HCC). While conventional systems assess hepatic function, they may not fully capture structural fibrosis. This study evaluated the whether preoperative Fibrosis‐4 (FIB‐4) index is associated with severe complications and “endogenous organ failure” (EOF: systemic decompensation unaccompanied by localized surgical‐site complications).

Methods: This retrospective study analyzed 1778 HCC patients undergoing hepatectomy between 2001 and 2020. A restricted cubic spline (RCS) model identified the optimal preoperative FIB‐4 cutoff for predicting major complications (Clavien‐Dindo [C‐D] Grade ≥ IIIa). Following stratification by this cutoff, intergroup comparisons and multivariable logistic regression analyses were performed to identify independent predictors of major and severe (C‐D Grade ≥ IIIb) complications.

Results: RCS analysis suggested a FIB‐4 threshold of 5.0 for an increased trend in complication risk. The High FIB‐4 index group (≥ 5.0, n = 385) showed a higher frequency of severe complications (7.0% vs. 3.4%) and EOF (3.1% vs. 0.4%) compared to the Low FIB‐4 index group (< 5.0, n = 1393). Among patients developing life‐threatening complications (C‐D Grade ≥ IV), 92.3% of the High FIB‐4 index group presented with EOF. In multivariable analyses, FIB‐4 ≥ 5.0 was consistently and independently associated with both major and severe complications.

Conclusion: A preoperative FIB‐4 ≥ 5.0 was associated with an increased incidence of severe complications, particularly EOF, after hepatectomy. This simple index could serve as a clinical indicator of systemic vulnerability, enhancing surgical risk stratification beyond traditional functional markers.

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Cite

BibTeXRIS
BibTeX
@article{nakamura2026preoperative,
  title = {{Preoperative FIB‐4 Index as a Potential Factor Associated With Severe Postoperative Complications and Endogenous Organ Failure After Hepatectomy for Hepatocellular Carcinoma}},
  author = {Masanori Nakamura and Yukiyasu Okamura and Osamu Aramaki and Nao Yoshida and Yusuke Mitsuka and Hayato Abe and Shunsuke Yamagishi and Yasuhiro Okumura and Kyongsun Pak and Shinobu Masuda},
  journal = {Annals of Gastroenterological Surgery},
  year = {2026},
  month = aug,
  doi = {10.1002/ags3.70263},
  url = {https://doi.org/10.1002/ags3.70263},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Preoperative FIB‐4 Index as a Potential Factor Associated With Severe Postoperative Complications and Endogenous Organ Failure After Hepatectomy for Hepatocellular Carcinoma
AU  - Masanori Nakamura
AU  - Yukiyasu Okamura
AU  - Osamu Aramaki
AU  - Nao Yoshida
AU  - Yusuke Mitsuka
AU  - Hayato Abe
AU  - Shunsuke Yamagishi
AU  - Yasuhiro Okumura
AU  - Kyongsun Pak
AU  - Shinobu Masuda
PY  - 2026
DA  - 2026/08/14
JO  - Annals of Gastroenterological Surgery
DO  - 10.1002/ags3.70263
UR  - https://doi.org/10.1002/ags3.70263
AB  - Background: Liver fibrosis influences tolerance to surgical stress, dictating postoperative complication risks after hepatectomy for hepatocellular carcinoma (HCC). While conventional systems assess hepatic function, they may not fully capture structural fibrosis. This study evaluated the whether preoperative Fibrosis‐4 (FIB‐4) index is associated with severe complications and “endogenous organ failure” (EOF: systemic decompensation unaccompanied by localized surgical‐site complications).  Methods: This retrospective study analyzed 1778 HCC patients undergoing hepatectomy between 2001 and 2020. A restricted cubic spline (RCS) model identified the optimal preoperative FIB‐4 cutoff for predicting major complications (Clavien‐Dindo [C‐D] Grade ≥ IIIa). Following stratification by this cutoff, intergroup comparisons and multivariable logistic regression analyses were performed to identify independent predictors of major and severe (C‐D Grade ≥ IIIb) complications.  Results: RCS analysis suggested a FIB‐4 threshold of 5.0 for an increased trend in complication risk. The High FIB‐4 index group (≥ 5.0, n = 385) showed a higher frequency of severe complications (7.0% vs. 3.4%) and EOF (3.1% vs. 0.4%) compared to the Low FIB‐4 index group (< 5.0, n = 1393). Among patients developing life‐threatening complications (C‐D Grade ≥ IV), 92.3% of the High FIB‐4 index group presented with EOF. In multivariable analyses, FIB‐4 ≥ 5.0 was consistently and independently associated with both major and severe complications.  Conclusion: A preoperative FIB‐4 ≥ 5.0 was associated with an increased incidence of severe complications, particularly EOF, after hepatectomy. This simple index could serve as a clinical indicator of systemic vulnerability, enhancing surgical risk stratification beyond traditional functional markers.
SN  - 2475-0328
ER  -