Evidence map›Paper›PMID 40749013›Full record

ArticlePloS one2025

Fibrosis-4 index as a predictor of all-cause and cardiovascular mortality in patients with chronic kidney disease.

Zheng-Yang Zhu, Ke-Jun Ren, Xiao-Wei Duan, Xu-Lei Hu, Yong Lv, Dong Wang, Hua Jin, Lei Zhang

Abstract read
In one paragraph

Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Zheng-Yang ZhuThe First Clinical Medical College, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.ORCID https://orcid.org/0009-0002-7903-9743
Ke-Jun RenThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.
Xiao-Wei DuanThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.
Xu-Lei HuThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.
Yong LvThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.
Dong WangThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.
Hua JinThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.
Lei ZhangThe First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei City, Anhui Province, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 (n = 28,231, including 4,907 chronic kidney disease (CKD) patients) with weighted analyses and, through variance inflation factor (VIF) assessment to verify covariate selection, supported model validity, to demonstrate for the first time that the Fibrosis-4 (FIB4) index serves as an independent predictor of all-cause and cardiovascular disease (CVD)-related mortality in CKD patients. Weighted logistic regression confirmed FIB4 index as a significant independent predictor of CKD risk (fully adjusted odds ratios (OR) 1.85, 95% confidence interval (CI) 1.64-2.08), with strong dose-response gradient (Q4 OR 3.51-6.02). Multivariable Cox proportional hazards regression models revealed that each 1-unit increase in the FIB4 index was associated with a 34% elevated risk of all-cause mortality (hazard ratio (HR) = 1.34, 95%CI: 1.27-1.41, p < 0.001) and a 34% increased risk of CVD mortality (HR = 1.34, 95% CI: 1.24-1.44, p < 0.001). Restricted cubic spline (RCS) analysis identified nonlinear threshold effects at inflection points of 1.84 (all-cause mortality) and 1.74 (CVD mortality), with mortality risks escalating sharply beyond these thresholds (all-cause HR = 2.57; CVD HR = 2.85). Receiver operating characteristic (ROC) curve analysis demonstrated robust predictive performance (area under the curve (AUC): 0.799 for all-cause mortality; 0.801 for CVD mortality). Subgroup analyses highlighted heightened risks among non-Hispanic Black individuals, older adults, and those with low physical activity. Mediation analysis indicated that neutrophil-to-lymphocyte ratio (NLR) mediated 5.48% of the FIB4-all-cause mortality association and 5.83% of the CVD mortality association, though direct effects predominated (94.52% and 94.17%, respectively). These findings establish the FIB4 index as a practical, evidence-based tool for risk stratification in CKD patients, offering critical insights for personalized clinical management.

Indexed as

Cardiovascular DiseasesRenal Insufficiency, ChronicAdultAgedFemaleHumansMaleMiddle AgedNutrition SurveysProportional Hazards ModelsRisk Factors

Identifiers

PMID40749013
PMCPMC12316213

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.