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CPE-005 · Fibrosis risk
LV-FIB-01: FIB-4 and its stratum
FIB-4 and its stratum. Evaluates age, AST, ALT and platelets available.
Condition
- age, AST, ALT and platelets available
What it reports
- FIB-4 = age × AST ÷ (platelets × √ALT)
- Low risk: below 1.3 (below 2.0 from age 65)
- Indeterminate: 1.3 to 2.67 (2.0 to 2.67 from age 65)
- High risk: above 2.67
Diagnostic boundary
- A rule-out test for advanced fibrosis, not a diagnosis of fibrosis.
Evidence
- EV-AASLD-2023Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.Supports: FIB-4 first for risk stratification; thresholds <1.3 and >2.67; elastography 8 and 12 kPa; ELF 7.7 and 9.8 ALT upper limits near 29–33 U/L (men) and 19–25 U/L (women) Cardiovascular risk is the leading cause of death in MASLD
- EV-MCPHERSON-2017McPherson 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.Supports: FIB-4 lower cutoff of 2.0 in patients aged 65 and over
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
LIVER-FX-01
Steatosis with metabolic risk and a low FIB-4
A 52-year-old man with fatty liver on ultrasound, BMI 31 and triglycerides 190.
LIVER-FX-02
Type 2 diabetes, no imaging yet
A 58-year-old with diabetes and normal enzymes: the screening question.
LIVER-FX-03
Indeterminate FIB-4
FIB-4 of 2.0 in a 56-year-old with steatosis.
LIVER-FX-04
High FIB-4
FIB-4 above 5 in a 63-year-old man with low platelets.
LIVER-FX-05
FIB-4 of 1.65 at age 70
Low risk under the age-adjusted cutoff of 2.0.
LIVER-FX-06
Stiffness 14 kPa with a low FIB-4
Discordant tests: the elastography result prevails as a warning.
LIVER-FX-07
ELF 10.1
A high ELF with FIB-4 in the indeterminate range.
LIVER-FX-08
Alcohol in the MetALD range
A woman drinking about 35 g a day with steatosis and metabolic risk.
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