Deniz KUTUK, Gurkan DEGIRMENCIOGLU
İstanbul Kuzey Klinikleri Dergisi - 2026;13(3):280-287
OBJECTIVE: This study aimed to investigate whether pre-operative composite indices derived from routine laboratory parameters, namely the fibrosis-4 (FIB-4) index, the aspartate aminotransferase-to-platelet ratio index (APRI), and the homeostatic model assessment of insulin resistance (HOMA-IR), were associated with post-operative percentage of excess weight loss (%EWL) after laparoscopic sleeve gastrectomy (LSG). METHODS: This retrospective cohort study included 91 adults who underwent LSG at a tertiary referral center. Pre-operative FIB-4, APRI, and HOMA-IR values were calculated from routinely obtained clinical and biochemical parameters. The primary endpoint was %EWL during post-operative follow-up. Patients were also classified as successful (%EWL >=50%) or suboptimal (%EWL <50%) responders. Comparative analyses, correlation analyses, and multivariable linear regression were performed. RESULTS: The cohort had a mean age of 39.2+/-10.0 years and was predominantly female (80.2%). Mean baseline body mass index (BMI) was 45.1+/-6.3 kg/m2. Mean post-operative %EWL was 51.0+/-20.2%, whereas total weight loss reached 26.5+/-8.4%. Marked post-operative metabolic improvement was observed, including significant declines in HOMA-IR, fasting glucose, triglycerides, alanine aminotransferase, and glycated hemoglobin. However, neither FIB-4 nor APRI nor HOMA-IR demonstrated a significant linear association with %EWL, and none remained an independent predictor in the regression model adjusted for age and baseline BMI. In subgroup analyses, the suboptimal weight loss group had a significantly higher baseline BMI and a borderline-higher triglyceride level. CONCLUSION: Pre-operative FIB-4, APRI, and HOMA-IR appear valuable for metabolic and hepatic phenotyping before surgery, but they do not provide sufficient standalone prognostic discrimination for early post-operative %EWL after LSG. Baseline adiposity may remain more informative than these composite indices for identifying patients at risk of suboptimal relative weight loss.
