FIB-4 Index
Non-invasive assessment of liver fibrosis in chronic liver disease (NAFLD, hepatitis B/C). Cut-offs 1.30 and 2.67 are for fatty liver disease (Shah 2009); FIB-4 is less reliable under 35, and from age 65 a lower cut-off of 2.0 is used (McPherson 2017).
Score interpretation
FIB-4 < 1.3: Low fibrosis risk. NPV 90% for advanced fibrosis (F3–F4).
→ Advanced fibrosis unlikely. Recheck in 1–2 years. Address metabolic risk factors (NAFLD: weight loss, diabetes control).
FIB-4 1.3–2.67: Indeterminate zone. Cannot reliably exclude advanced fibrosis.
→ Consider additional non-invasive testing: FibroScan (transient elastography) or FibroTest. Hepatology referral.
FIB-4 > 2.67: Advanced fibrosis likely. PPV 65% for F3–F4 (cirrhosis range).
→ Hepatology referral. Consider FibroScan. Varices screening. HCC surveillance (USS + AFP 6-monthly).
Interpretation bands for the FIB-4. Apply clinical judgement and local guidance.
References
- Sterling RK et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006.
- European Association for the Study of the Liver (EASL). Clinical Practice Guidelines: Management of NAFLD. J Hepatol. 2016.
Related
Curated clinical cross-links plus same-class fallbacks.
- Spironolactone (Ascites / Cirrhosis) · Aldosterone Antagonist / Potassium-Sparing Diuretic
- Furosemide (Ascites / Cirrhosis) · Loop Diuretic
- Entecavir · Antiviral — Hepatitis B (Nucleoside Analogue)
- Tenofovir (TDF/TAF) · Antiviral — Hepatitis B (Nucleotide Analogue)
- Glecaprevir / Pibrentasvir · Antiviral — Hepatitis C (Pan-Genotypic DAA)
- Sofosbuvir / Velpatasvir · Antiviral — Hepatitis C (Pan-Genotypic DAA)
- Sepsis Screening and Sepsis Six · UK Sepsis Trust; NICE NG51; Surviving Sepsis Campaign 2021
- Unintentional Weight Loss Workup · NICE NG12; BSG
- Chronic Fatigue Workup · NICE NG206; BMJ Best Practice
- Lymphadenopathy Workup · NICE NG12; BMJ Best Practice
- Pre-op Medical Clearance · NICE NG45; ESC 2022
- Secondary Hypertension Workup · NICE NG136; ESH 2023
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.