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fibrosis-4/5 index; fibrosis-4/5 score; FIB-4/5 index; FIB-4/5 score

Indications: - estimation of hepatic fibrosis in liver disease - non-alcoholic fatty liver - hepatitis B - hepatitis C Procedure: - fibrosis-4 score - derived from age, serum AST, serum ALT & platelet count - can be obtained using online calculators [2,3,4] - fibrosis-5 score [7] - derived form waist circumference, body mass index (kg/m2), diabetes mellitus, serum AST, & platelet count Interpretation: - patients with a score of < 1.3 are unlikely to have fibrosis & should be periodically reassessed [5] - further evaluation by transient elastography for patients with a score of > 1.3 [5] - patients with FIB-4 scores of 1.3-2.67 should have transient elastography with FibroScan [6] - patients with low liver stiffness < 8 kPa can be followed in primary care - patients with intermediate liver stiffness > 8 kPa or high > 12 kPa should be referred to a hepatologist - patients with FIB-4 scores > 2.67 should be referred to a hepatologist [6]

Related

hepatitis C virus (HCV) FibroSURE

General

numerical rating scale (NRS)

References

  1. Sterling RK, Lissen E, Clumeck N et al Development of a simple noninvasive index to predict significant fibrosis patients with HIV/HCV co-infection. Hepatology 2006;43:1317-1325. PMID: 16729309
  2. Fibrosis-4 (FIB-4) Index for Liver Fibrosis Noninvasive estimate of liver scarring in HCV & HBV patients, to assess need for biopsy. https://www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis
  3. Fibrosis-4 (FIB-4) Calculator University of Washington https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4
  4. FIB-4 Calculator https://www.omnicalculator.com/health/fib-4
  5. Rinella ME et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 2023 May; 77:1797. PMID: 36727674 https://journals.lww.com/hep/Fulltext/2023/05000/AASLD_Practice_Guidance_on_the_clinical_assessment.31.aspx
  6. Kanwal F, Shubrook JH, Adams LA et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology 2021 Nov; 161:1657. PMID: 34602251 https://www.gastrojournal.org/article/S0016-5085(21)03384-9/fulltext
  7. van Kleef LA, Francque SM, Prieto-Ortiz JE, et al. Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) Score Predicts Liver Fibrosis Risk and Outcome in the General Population With Metabolic Dysfunction. Gastroenterology. 2024 Mar 19:S0016-5085(24)00300-7 PMID: 38513745 https://www.gastrojournal.org/article/S0016-5085(24)00300-7/fulltext?