Clinical value of the fibrosis-4 index in predicting decompressive craniectomy after mechanical thrombectomy in stroke.

The FIB-4 index at admission predicted the need for decompressive craniectomy in large artery occlusion stroke patients undergoing mechanical thrombectomy.

• ROC analysis identified a FIB-4 cutoff value of 1.24
• Area under the curve was 0.85
• Sensitivity was 70% and specificity was 93% for predicting the need for decompressive surgery
• Non-adjusted univariate logistic regression analysis showed the FIB-4 index was a strong independent predictor of DC

Patients who underwent decompressive craniectomy had significantly higher FIB-4 index values compared to those who did not.

• The DC group was significantly older than the non-DC group
• DC patients had higher National Institutes of Health Stroke Scale scores
• DC patients had higher modified Rankin Scale scores
• DC patients had higher systolic and diastolic blood pressures and higher rates of hemorrhagic transformation

The study was a retrospective analysis of patients undergoing mechanical thrombectomy at two comprehensive stroke centers in Turkey.

• Data were collected from two comprehensive stroke centers in southern and eastern Turkey
• Study period was January 2022 to December 2024
• Patients were divided into two groups based on whether they received decompressive craniectomy
• The FIB-4 index was calculated using the formula: (ASAT × age) / (platelet count × √ALAT)

Liver fibrosis, as measured by the FIB-4 index, may increase the risk of stroke-related complications including brain edema and hemorrhagic transformation after mechanical thrombectomy.

• Recent studies suggest that liver fibrosis may increase the risk of stroke even after adjusting for conventional cardiovascular risk factors
• Successful reperfusion after mechanical thrombectomy may result in ischemia/reperfusion injury causing brain edema or hemorrhagic transformation
• DC patients had significantly higher rates of hemorrhagic transformation
• The FIB-4 index is a simple, noninvasive marker of liver fibrosis calculated using age, ASAT, ALAT, and platelet count