FIB-4 index associated with mortality risk of patients with systemic lupus erythematosus: a large retrospective cohort study.

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 ( 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.