Higher FIB-4 scores are associated with increased odds of poor stroke outcomes and mortalityHigher Fibrosis Scores Linked to Worse Stroke Outcomes

Frontiers in Medicine Published August 11, 2026 DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Note that higher FIB-4 scores are associated with increased risks of stroke complications and mortality, but require further validation.

This meta-analysis synthesizes evidence from 20 cohort studies and 2 cross-sectional studies to evaluate the relationship between the Fibrosis-4 index (FIB-4) and clinical outcomes in patients with stroke. The analysis included both categorical and continuous measurements of the FIB-4 score.

For categorical FIB-4 measurements, higher scores were associated with greater odds of overall stroke (OR 1.86; 95% CI: 1.63–2.14), ischemic stroke (OR 2.03; 95% CI: 1.72–2.40), and symptomatic intracranial hemorrhage (OR 2.52; 95% CI: 1.79–3.53). Furthermore, categorical FIB-4 was associated with higher odds of poor functional outcomes (OR 2.88; 95% CI: 2.47–3.35) and all-cause mortality (OR 2.98; 95% CI: 2.51–3.53). Continuous FIB-4 measurements also showed higher hazards or odds for overall stroke (HR 1.08; 95% CI: 1.02–1.14), symptomatic intracranial hemorrhage (OR 1.33; 95% CI: 1.20–1.48), poor functional outcome (OR 1.26; 95% CI: 1.11–1.43), and all-cause mortality (HR 1.08; 95% CI: 1.03–1.12).

The authors note that the categorical overall-stroke analysis was exploratory and that prediction intervals crossed the null for continuous analyses of poor functional outcome and all-cause mortality. While FIB-4 may provide adjunctive risk information, it is not yet a validated tool for routine clinical use. Prospective validation is required to determine its incremental clinical value.

How this fits prior evidence

This meta-analysis addresses a gap in identifying prognostic indicators for stroke outcomes. While other evidence focuses on interventions such as ultrasound stimulation or intravenous thrombolysis to improve functional outcomes, this study explores the role of FIB-4 as an adjunctive risk indicator. The finding that higher FIB-4 scores correlate with increased odds of mortality and poor outcomes provides a potential biomarker for risk stratification in patients with ischemic stroke or intracranial hemorrhage.

Researchers analyzed data from 20 cohort studies and 2 cross-sectional studies to look at the relationship between the Fibrosis-4 (FIB-4) index and stroke outcomes. The FIB-4 is a tool often used to measure liver health. The study looked at how this score related to various conditions, including ischemic stroke and intracranial hemorrhage.

The results showed that higher categorical FIB-4 scores were linked to greater odds of overall stroke, ischemic stroke, and symptomatic intracranial hemorrhage. Additionally, patients with higher scores had increased odds of poor functional outcomes and all-cause mortality. Continuous measurements also showed a link between the score and these risks.

It is important to note that this study shows an association only, not a direct cause. Because the data comes from observational studies, more research is needed to see if this tool can be used in daily medical practice. The FIB-4 index is not yet a validated tool for routine clinical use, and some specific results were less certain due to small statistical margins.

What this means for you:

Higher FIB-4 scores are linked to worse outcomes after stroke, but more research is needed before clinical use.

Common questions

What is the FIB-4 index?

The FIB-4 index is a tool used to assess liver health. This study looked at how this score relates to stroke outcomes. The results showed that higher scores were linked to greater odds of overall stroke, ischemic stroke, and symptomatic intracranial hemorrhage.

Does a high FIB-4 score cause a stroke?

The study shows an association between the FIB-4 index and stroke outcomes, but it does not prove that one causes the other. Because the data came from observational studies, it only indicates a link rather than a direct cause.

Can doctors use the FIB-4 score to predict stroke recovery?

The study suggests the FIB-4 may provide extra risk information, but it is not yet a validated tool for routine clinical use. More research is needed to determine its value before it can be used regularly by doctors.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedAug 2026

View Original Abstract ↓

ObjectiveThis meta-analysis evaluated the associations between the Fibrosis-4 index (FIB-4) and overall stroke, ischemic stroke, hemorrhagic outcomes, poor functional outcome, and all-cause mortality.MethodsPubMed, Embase, and the Cochrane Library were searched from inception to November 4, 2025. Cohort and cross-sectional studies evaluating categorical or continuous FIB-4 were eligible. Quantitative syntheses were stratified by outcome, FIB-4 modeling approach, and effect measure, with odds ratios (ORs) and hazard ratios (HRs) analyzed separately. Prediction intervals were calculated for random-effects analyses containing at least three independent estimates.ResultsTwenty-two studies, including 20 cohort studies and two cross-sectional studies, were included, of which 20 contributed to at least one quantitative synthesis. Elevated categorical FIB-4 was associated with greater odds of overall stroke (OR = 1.86, 95% CI: 1.63–2.14), ischemic stroke (OR = 2.03, 95% CI: 1.72–2.40), symptomatic intracranial hemorrhage (OR = 2.52, 95% CI: 1.79–3.53), poor functional outcome (OR = 2.88, 95% CI: 2.47–3.35), and all-cause mortality (OR = 2.98, 95% CI: 2.51–3.53). Continuous FIB-4 was also associated with overall stroke (HR = 1.08, 95% CI: 1.02–1.14), symptomatic intracranial hemorrhage (OR = 1.33, 95% CI: 1.20–1.48), poor functional outcome (OR = 1.26, 95% CI: 1.11–1.43), and all-cause mortality (HR = 1.08, 95% CI: 1.03–1.12). However, prediction intervals crossed the null for the continuous analyses of poor functional outcome and all-cause mortality, and the categorical overall-stroke analysis was exploratory.ConclusionHigher FIB-4 was associated with stroke and adverse stroke-related outcomes across several observational analyses. FIB-4 may provide adjunctive risk information, but prospective validation and formal assessment of its incremental clinical value are required before routine implementation.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/search, identifier: CRD420251207801.

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Common questions

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