FIB-4 Index
Non-invasive estimate of advanced liver fibrosis from age, transaminases and platelets.
When to use it. First-line triage for advanced fibrosis in fatty liver disease or chronic viral hepatitis.
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Limits of this score. FIB-4 is a RULE-OUT test. The low cut-off is what it does well; an indeterminate or high result needs elastography or a specialist opinion, not a diagnosis. It is unreliable under 35 and over 65 — in the over-65s the low cut-off is raised to 2.0 to stop it over-calling — and any cause of thrombocytopenia inflates it.
Sources
- Sterling RK, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43:1317–25.
- EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity. J Hepatol 2021;75:659–89.
Where this is written from. This site is written from Indian clinical practice. Drug availability and brand names, vaccination schedules, national health programmes and some reference cut-offs differ between countries — a schedule or a threshold that is standard here may not be standard where you are. If you are reading outside India, check anything on this page against your own country’s guidance before you act on it.
Educational use only — not medical advice. Never a substitute for clinical judgement.