Karotis Arter Stentlemesi Uygulanan Hastalarda İşlem Öncesi Fibrozis-4 İndeksi Geçirilmiş Serebrovasküler Olaylar İle Bağımsız Olarak İlişkilidir

Öz

Amaç: Fibrozis-4 (FIB-4) indeksi, başlangıçta hepatik fibrozisi değerlendirmek amacıyla geliştirilmiş basit ve noninvaziv bir belirteç olup, son yıllarda sistemik inflamasyon ve aterosklerozun potansiyel bir göstergesi olarak dikkat çekmektedir. Bu çalışmada, karotis arter stentlemesi (KAS) uygulanan hastalarda işlem öncesi FIB-4 indeksi ile geçirilmiş serebrovasküler olaylar arasındaki ilişkinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışmaya, anlamlı karotis arter darlığı nedeniyle KAS uygulanan ardışık 221 hasta dahil edildi. Hastalar geçirilmiş serebrovasküler olay öyküsüne göre gruplandırıldı. Grupların demografik, klinik ve laboratuvar özellikleri karşılaştırıldı. Geçirilmiş serebrovasküler olayların bağımsız belirleyicilerini saptamak amacıyla çok değişkenli lojistik regresyon analizi yapıldı. ROC eğrisi analizi, FIB-4 indeksinin ayırt edici gücünü değerlendirmek amacıyla gerçekleştirildi ve optimal kesim noktası, duyarlılık ve özgüllük arasındaki en iyi dengeye dayalı olarak Youden indeksi kullanılarak belirlendi. Bulgular: Toplam 221 hastanın 133'ünde (%60,2) geçirilmiş serebrovasküler olay öyküsü mevcuttu. Geçirilmiş serebrovasküler olay öyküsü bulunan hastalarda trombosit sayısı ve HDL kolesterol düzeyleri daha düşük, açlık glukozu ve FIB-4 indeksi ise anlamlı olarak daha yüksekti (tümü p<0,05). Çok değişkenli analizde kronik böbrek hastalığı (OR: 3,06; %95 GA: 1,46-6,39; p=0,003), düşük HDL kolesterol düzeyi (OR: 0,96; %95 GA: 0,93-0,99; p=0,011) ve FIB-4 indeksindeki her 1 birimlik artış (OR: 2,19, %95 GA: 1,29-3,73; p=0,004) geçirilmiş serebrovasküler olaylarla bağımsız olarak ilişkili bulundu. ROC analizinde FIB-4 indeksinin ayırt edici performansının sınırlı olduğu görüldü (EAA=0,611; %95 GA: 0,535-0,687; p=0,005). 1,54 FIB-4 kesim değeri, geçirilmiş serebrovasküler olayları belirlemede %51,1 duyarlılık ve %64,8 özgüllük sağladı. Sonuç: İşlem öncesi yüksek FIB-4 indeksi, karotis arter stentlemesi uygulanan hastalarda geçirilmiş serebrovasküler olaylarla bağımsız olarak ilişkili bulundu. Ayırt edici performansı sınırlı olmakla birlikte, FIB-4 indeksi, sistemik vasküler risk hakkında tamamlayıcı bilgi sağlayabilecek, düşük maliyetli ve kolay erişilebilir bir biyobelirteç olarak kullanılabilir. Bu ilişkinin doğrulanması ve FIB-4 indeksinin bu popülasyondaki potansiyel klinik kullanım alanının belirlenmesi için daha geniş kapsamlı, prospektif ve çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Karotis arter stentlemesi
• Fibrozis-4 indeksi
• Serebrovasküler hastalık
• Ateroskleroz
• Karaciğer fibrozisi

Destekleyen Kurum

YOK

Etik Beyan

Çalışma protokolü, Akdeniz Üniversitesi Etik Kurulu tarafından onaylanmıştır (Onay No: TBAEK-510; 4 Haziran 2026). Araştırma, Helsinki Bildirgesi'nde belirtilen etik ilkelere uygun olarak yürütülmüştür. Çalışmanın retrospektif tasarımı nedeniyle yazılı bilgilendirilmiş gönüllü olurunun alınması gerekliliği etik kurul tarafından kaldırılmıştır.

Teşekkür

YOK

Preprocedural Fibrosis-4 Index Is Independently Associated with Previous Cerebrovascular Events in Patients Undergoing Carotid Artery Stenting

Öz

Objective The Fibrosis-4 (FIB-4) index is a simple, non-invasive marker originally developed to estimate hepatic fibrosis and has recently emerged as a potential indicator of systemic inflammation and atherosclerosis. This study investigated the association between the preprocedural FIB-4 index and previous cerebrovascular events in patients undergoing carotid artery stenting (CAS). Materials and Methods This retrospective observational study included 221 consecutive patients who underwent CAS for significant carotid artery stenosis. Patients were categorized according to the presence or absence of previous cerebrovascular events. Demographic, clinical, and laboratory characteristics were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of previous cerebrovascular events. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of the FIB-4 index, and the optimal cut-off value was determined using the Youden index, based on the best balance between sensitivity and specificity. Results Among the 221 patients, 133 (60.2%) had a history of previous cerebrovascular events. Compared with patients without previous cerebrovascular events, those with previous cerebrovascular events had significantly lower platelet counts and HDL cholesterol levels and significantly higher fasting glucose and FIB-4 index values (all p < 0.05). In multivariable logistic regression analysis, chronic kidney disease (OR: 3.06, 95% CI: 1.46–6.39, p = 0.003), lower HDL cholesterol (OR: 0.96 per 1 mg/dL increase, 95% CI: 0.93–0.99, p = 0.011), and a higher FIB-4 index (OR: 2.19 per 1-unit increase 95% CI: 1.29–3.73, p = 0.004) were independently associated with previous cerebrovascular events. ROC analysis demonstrated modest discriminatory performance of the FIB-4 index (AUC: 0.611, 95% CI: 0.535–0.687, p = 0.005). A FIB-4 value of 1.54 yielded a sensitivity of 51.1% and a specificity of 64.8% for identifying patients with previous cerebrovascular events. Conclusion An elevated preprocedural FIB-4 index was independently associated with previous cerebrovascular events in patients undergoing carotid artery stenting. Although its discriminatory performance was modest, the FIB-4 index may serve as an inexpensive and readily available biomarker that may provide complementary information regarding systemic vascular risk. Larger prospective multicenter studies are warranted to validate this association and determine the potential clinical utility of FIB-4 in this population.

Anahtar Kelimeler

• Carotid artery stenting
• Fibrosis-4 index
• Cerebrovascular disease
• Atherosclerosis
• Liver fibrosis

Destekleyen Kurum

N.A.

Etik Beyan

The study protocol received approval from the Ethics Committee of Akdeniz University (Approval No. TBAEK-510; June 4, 2026). The investigation complied with the ethical principles outlined in the Declaration of Helsinki. Owing to the retrospective nature of the study, the requirement for written informed consent was waived by the ethics committee.

Teşekkür

N.A.

Kaynakça

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