Original Article

Fibrosis-4 Score and Postoperative Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease

Volume 37 · Issue 1 Publish Date: January 5, 2026
Fatih Eren ORCID Mehmet Refik Goktug ORCID Derya Ari ORCID Gulsah Fidan Ozkumur ORCID Eda Nur Bulbuller ORCID Genco Gencdal ORCID Yuksel Guleryuzlu ORCID Caglayan Keklikkiran ORCID Dinc Dincer ORCID Dilara Turan Gokce ORCID Askin Erdogan ORCID Meral Akdogan Kayhan ORCID Mehmet Kursad Keskin ORCID Selcan Akesen ORCID Gokhan Ocakoglu ORCID Murat Kiyici ORCID
Full Text PDF
DOI

Published In

Turkish Journal of Gastroenterology

Volume 37 · Issue 1

Pages: 127-135

History

Published Online: January 5, 2026

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2026 Fatih Eren, Mehmet Refik Goktug, Derya Ari, Gulsah Fidan Ozkumur, Eda Nur Bulbuller, Genco Gencdal, Yuksel Guleryuzlu, Caglayan Keklikkiran, Dinc Dincer, Dilara Turan Gokce, Askin Erdogan, Meral Akdogan Kayhan, Mehmet Kursad Keskin, Selcan Akesen, Gokhan Ocakoglu, Murat Kiyici

Fatih Eren ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Mehmet Refik Goktug ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Derya Ari ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Türkiye
Gulsah Fidan Ozkumur ORCID
Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
Eda Nur Bulbuller ORCID
Department of Internal Medicine, Alaaddin Keykubat University, Antalya, Türkiye
Genco Gencdal ORCID
Department of Gastroenterology and Hepatology, Koç University School of Medicine, İstanbul, Türkiye
Yuksel Guleryuzlu ORCID
Department of Gastroenterology, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Türkiye
Caglayan Keklikkiran ORCID
Department of Gastroenterology, Recep Tayyip Erdogan University School of Medicine, Rize, Türkiye
Dinc Dincer ORCID
Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
Dilara Turan Gokce ORCID
Department of Gastroenterology, Ankara Sincan Training and Research Hospital, Ankara, Türkiye
Askin Erdogan ORCID
Department of Gastroenterology, Alaaddin Keykubat University, Antalya, Türkiye
Meral Akdogan Kayhan ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Türkiye
Mehmet Kursad Keskin ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Selcan Akesen ORCID
Department of Anaesthesiology and Reanimation, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Gokhan Ocakoglu ORCID
Department of Biostatistics, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Murat Kiyici ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Eren, F., Goktug, M. R., Ari, D., Ozkumur, G. F., Bulbuller, E. N., Gencdal, G., … Kiyici, M. (2026). Fibrosis-4 Score and Postoperative Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease. Turkish Journal of Gastroenterology, 37(1), 127–135. https://doi.org/10.5152/tjg.2026.25693
Endnote/Zotero/Mendeley (RIS) BibTeX
Full Text Full Text PDF

Abstract

Background/Aims:  The  prevalence  of  metabolic  dysfunction-associated  steatotic  liver  disease  (MASLD)  is  increasing  globally.  The  Fibrosis-4 (FIB-4) score is a noninvasive biomarker used for assessing potential advanced fibrosis. The study aimed to evaluate the role of the FIB-4 score in predicting postoperative complications and mortality in patients undergoing surgery.

Materials and Methods: This multicenter retrospective study included 11 072 patients who underwent surgery under general anesthesia. Demographic and clinical data—including age, gender, comorbidities, FIB-4 scores, American Society of Anesthesiologists classification, postoperative complications, and mortality—were analyzed.

Results:  A  total  of  1667  MASLD  patients  were  included.  Patients  were  classified  based  on  FIB-4  scores:  70%  (n  =  1167)  had  FIB-4  <1.30, 25.1% (n = 418) had 1.30 < FIB-4 ≤ 2.67, and 4.9% (n = 82) had FIB-4 ≥ 2.67. Due to the limited number of patients with possible advanced fibrosis (FIB-4 ≥ 2.67), propensity score (PS) matching was performed. After PS matching, patients with a high FIB-4 score exhibited a significantly higher rate of postoperative complications (P < .001), and 12-month mortality was elevated (11%), although the difference was not statistically significant (P = .481).

Conclusion: A high FIB-4 score may serve as a predictive marker for postoperative complications in patients with MASLD undergoing surgery.

Cite this article as: Eren F, Goktug MR, Ari D, et al. Fibrosis-4 score and postoperative outcomes in metabolic dysfunction-associated steatotic liver disease. Turk J Gastroenterol. 2026;37(1):127-135.

Most read articles by the same author(s)

1 2 3 4 > >> 
Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 37 · Issue 1
Pages 127-135
DOI 10.5152/tjg.2026.25693
History
Published Online January 5, 2026
License
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright
Copyright (c) 2026 Fatih Eren, Mehmet Refik Goktug, Derya Ari, Gulsah Fidan Ozkumur, Eda Nur Bulbuller, Genco Gencdal, Yuksel Guleryuzlu, Caglayan Keklikkiran, Dinc Dincer, Dilara Turan Gokce, Askin Erdogan, Meral Akdogan Kayhan, Mehmet Kursad Keskin, Selcan Akesen, Gokhan Ocakoglu, Murat Kiyici
Affiliations
Fatih Eren ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Mehmet Refik Goktug ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Derya Ari ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Türkiye
Gulsah Fidan Ozkumur ORCID
Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
Eda Nur Bulbuller ORCID
Department of Internal Medicine, Alaaddin Keykubat University, Antalya, Türkiye
Genco Gencdal ORCID
Department of Gastroenterology and Hepatology, Koç University School of Medicine, İstanbul, Türkiye
Yuksel Guleryuzlu ORCID
Department of Gastroenterology, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Türkiye
Caglayan Keklikkiran ORCID
Department of Gastroenterology, Recep Tayyip Erdogan University School of Medicine, Rize, Türkiye
Dinc Dincer ORCID
Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
Dilara Turan Gokce ORCID
Department of Gastroenterology, Ankara Sincan Training and Research Hospital, Ankara, Türkiye
Askin Erdogan ORCID
Department of Gastroenterology, Alaaddin Keykubat University, Antalya, Türkiye
Meral Akdogan Kayhan ORCID
Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Türkiye
Mehmet Kursad Keskin ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Selcan Akesen ORCID
Department of Anaesthesiology and Reanimation, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Gokhan Ocakoglu ORCID
Department of Biostatistics, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Murat Kiyici ORCID
Department of Gastroenterology, Bursa Uludağ University School of Medicine, Bursa, Türkiye
Cite this Article
Eren, F., Goktug, M. R., Ari, D., Ozkumur, G. F., Bulbuller, E. N., Gencdal, G., … Kiyici, M. (2026). Fibrosis-4 Score and Postoperative Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease. Turkish Journal of Gastroenterology, 37(1), 127–135. https://doi.org/10.5152/tjg.2026.25693
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX
Outlines