Prognostic value of the admission Fibrosis-4 index in non-traumatic subarachnoid hemorrhage

Abstract

Early prognostic assessment after non-traumatic subarachnoid hemorrhage (SAH) remains challenging because established clinical and radiological scales primarily quantify neurological injury and may not fully reflect systemic vulnerability. We investigated whether the admission Fibrosis-4 (FIB-4) index was associated with 28-day mortality and 90-day functional outcome in intensive care unit patients with non-traumatic SAH. This retrospective cohort study included 325 consecutive adults with computed tomography and/or computed tomography angiography-confirmed SAH admitted to a tertiary intensive care unit between January 2021 and June 2025. FIB-4 was calculated from age, platelet count, aspartate aminotransferase, and alanine aminotransferase measured at admission. The primary outcome was 28-day all-cause mortality; the secondary outcome was unfavorable 90-day functional status, defined as a modified Rankin Scale score of 3-6. Eighty-four patients (25.8%) died within 28 days. Median FIB-4 was higher in non-survivors than survivors (3.3 vs 1.6; p < 0.001). In multivariable logistic regression, hematocrit (odds ratio [OR] 0.857, 95% confidence interval [CI] 0.805-0.912), lactate (OR 2.693, 95% CI 1.676-4.328), and FIB-4 (OR 1.634, 95% CI 1.304-2.046) were independently associated with mortality. FIB-4 showed good discrimination (area under the curve 0.779, 95% CI 0.720-0.838), with an optimal cut-off of 2.45. Patients with FIB-4 ≥2.45 had higher 28-day mortality (52.7% vs 11.7%) and more unfavorable 90-day outcomes (77.7% vs 47.9%; both p < 0.001). Admission FIB-4 may provide a simple adjunct for early risk stratification in non-traumatic SAH.

Keywords

• Non-traumatic subarachnoid hemorrhage
• Fibrosis-4 index
• Mortality
• Functional outcome; intensive care
• Modified Rankin Scale

Ethical Statement

The Clinical Research Ethics Committee of Giresun Training and Research Hospital approved the study (approval No. 2025/19; 24 December 2025)

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