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HEPATOLOGY / CLINICAL RESEARCH
FIB-4 index associated with mortality risk of patients with systemic lupus erythematosus: a large retrospective cohort study
1
Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
2
Department of Rheumatology, Huai’an First People’s Hospital, Huai’an, China
3
Department of Rheumatology, Xuzhou Central Hospital, Xuzhou, China
4
Department of Rheumatology, the Third Affiliated Hospital of Soochow University, Changzhou, China
5
Department of Rheumatology, Lianyungang Second People’s Hospital, Lianyungang, China
6
Department of Rheumatology, Lianyungang First People’s Hospital, Lianyungang, China
7
Department of Rheumatology, Northern Jiangsu People’s Hospital, Yangzhou, China
8
Department of Rheumatology, Wuxi People’s Hospital, Wuxi, China
9
Department of Rheumatology, Jiangsu Province Hospital of TCM, Nanjing, China
10
Department of Rheumatology, Southeast University Zhongda Hospital, Nanjing, China
11
Department of Rheumatology, the First Affiliated Hospital of Soochow University, Suzhou, China
12
Department of Rheumatology, Wuxi TCM Hospital, Wuxi, China
13
Department of Rheumatology, Zhenjiang First People’s Hospital, Zhenjiang, China
14
Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
15
Department of Rheumatology, Jiangsu Province Hospital, Nanjing, China
16
Department of Rheumatology, Affiliated Hospital of Jiangsu University, Jiangsu, China
Submission date: 2020-01-20
Final revision date: 2020-02-17
Acceptance date: 2020-05-19
Online publication date: 2020-11-20
Publication date: 2026-02-28
Corresponding author
Lingyun Sun
Department of Rheumatology and Immunology The Affiliated Drum Tower Hospital Nanjing University Medical School 321 Zhongshan Road Nanjing 210008, China Phone: +86-25-6818-2422 Fax: +86-25-6818-2428
Department of Rheumatology and Immunology The Affiliated Drum Tower Hospital Nanjing University Medical School 321 Zhongshan Road Nanjing 210008, China Phone: +86-25-6818-2422 Fax: +86-25-6818-2428
Arch Med Sci 2026;22(1):141-154
KEYWORDS
TOPICS
ABSTRACT
Introduction:
A considerable proportion of patients with systemic lupus erythematosus (SLE) have liver enzyme abnormalities. We evaluated whether fibrosis-4 (FIB-4) was associated with increased mortality of SLE patients.
Material and methods:
A multicenter retrospective cohort study was conducted based on medical records of first-admission SLE patients who were hospitalized during 1999–2009 in Jiangsu province. FIB-4 was estimated by age, platelet (PLT) count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and FIB-4. A Cox model and a restricted cubic spline (RCS) model were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI).
Results:
During up to 15 years of follow-up, 226 deaths were observed among 2331 SLE patients. Increased overall mortality was associated with abnormal groups of PLT, ALT, AST, and high FIB-4 (≥ 1.92), with adjusted HRs (95% CI) of 1.58 (1.19–2.11), 1.54 (1.14–2.07), 1.58 (1.17–2.12), and 1.88 (1.42–2.50), respectively. Moreover, significant dose-response relationships were found between mortality of SLE and those indexes, and it was nonlinear for PLT (p < 0.001), ALT (p = 0.046) and FIB-4 (p < 0.001), but not AST (p = 0.109). In cause-specific analyses, high FIB-4 index was directly associated with death from liver failure and indirectly associated with other death from infection and neuropsychiatric impairment. We found no significant differences of areas under curves (AUCs) between FIB-4 index and the disease activity index score of SLE.
Conclusions:
This is the first report to describe the nonlinear association between FIB-4 index and increased mortality of SLE patients. The FIB-4 index may be used as an independent prognostic indicator for SLE patients.
A considerable proportion of patients with systemic lupus erythematosus (SLE) have liver enzyme abnormalities. We evaluated whether fibrosis-4 (FIB-4) was associated with increased mortality of SLE patients.
Material and methods:
A multicenter retrospective cohort study was conducted based on medical records of first-admission SLE patients who were hospitalized during 1999–2009 in Jiangsu province. FIB-4 was estimated by age, platelet (PLT) count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and FIB-4. A Cox model and a restricted cubic spline (RCS) model were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI).
Results:
During up to 15 years of follow-up, 226 deaths were observed among 2331 SLE patients. Increased overall mortality was associated with abnormal groups of PLT, ALT, AST, and high FIB-4 (≥ 1.92), with adjusted HRs (95% CI) of 1.58 (1.19–2.11), 1.54 (1.14–2.07), 1.58 (1.17–2.12), and 1.88 (1.42–2.50), respectively. Moreover, significant dose-response relationships were found between mortality of SLE and those indexes, and it was nonlinear for PLT (p < 0.001), ALT (p = 0.046) and FIB-4 (p < 0.001), but not AST (p = 0.109). In cause-specific analyses, high FIB-4 index was directly associated with death from liver failure and indirectly associated with other death from infection and neuropsychiatric impairment. We found no significant differences of areas under curves (AUCs) between FIB-4 index and the disease activity index score of SLE.
Conclusions:
This is the first report to describe the nonlinear association between FIB-4 index and increased mortality of SLE patients. The FIB-4 index may be used as an independent prognostic indicator for SLE patients.
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