Fibrosis-4_FIB-4_Index_for_Liver_Fibrosis_guideline v.1

Fibrosis-4 (FIB-4) Index for Liver Fibrosis predicts liver fibrosis.

Maryam Razavi

maryam.razavi@cambio.se

@CambioCDS

To estimate liver scarring in HCV and HBV patients, re-assess fibrosis trends in individual patients over time and, assess need for biopsy.

Use in patients with any known risk factors for liver disease, including chronic hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD) and the cholestatic and metabolic liver diseases. Patients with known liver fibrosis should have their fibrosis trended over time to evaluate for progression or stabilization. FIB-4 Formula: FIB-4 Score = (Age* x AST) / (Platelets x (ALT)^0.5) Variables: Age (years), AST (U/L), Platelet (*10^9/L), ALT (U/L). Interpretation: FIB-4 Score<1.45 = Approximate fibrosis stage 0-1 FIB-4 Score 1.45-3.25 = Approximate fibrosis stage 2-3 FIB-4 Score>3.25 = Approximate fibrosis stage 4-6 Age>=35: Alternative fibrosis assessment Age 36-64: - FIB-4 Score<1.3=Advanced fibrosis excluded - FIB-4 Score 1.3-2.67= Further investigation - FIB-4 Score>2.67=Advanced fibrosis likely Age>=65: - FIB-4 Score<2.0=Advanced fibrosis excluded - FIB-4 Score 2.0 -2.67= Further investigation - FIB-4 Score>2.67=Advanced fibrosis likely

Use with caution in patients <35 or >65 years old, as the score has been shown to be less reliable in these patients.

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. 2. Kim BK, et. al. Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. Liver Int. 2010 Apr;30(4):546-53. doi: 10.1111/j.1478-3231.2009.02192.x. Epub 2010 Jan 13. 3. Mcpherson S, Hardy T, Dufour JF, et al. Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis. Am J Gastroenterol. 2017;112(5):740-751. 4. Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104-12. 5. Tapper EB, Lok AS. Use of Liver Imaging and Biopsy in Clinical Practice. N Engl J Med. 2017;377(8):756-768.

OBSERVATION.basic_demographic.v1, OBSERVATION.lab_test-full_blood_count_anc.v1, OBSERVATION.lab_test-alt.v1, OBSERVATION.lab_test-ast.v1, EVALUATION.fibrosis_4_fib_4_index_for_liver_fibrosis.v0