FIB-4 combines age, AST, ALT and platelet count and is the first-line fibrosis test recommended by major liver societies for people with fatty liver. A value below 1.3 makes advanced fibrosis unlikely and supports routine care. Above that, elastography or a second-line panel sorts out who needs referral. The score is less reliable under 35 and over 65, where age distorts it.
- Calculate FIB-4 from age, AST, ALT and platelets in anyone with fatty liver or metabolic risk factors.
- Below 1.3, advanced fibrosis is unlikely; repeat in one to three years.
- Above 1.3, arrange elastography or a second-line test.
- Interpret with caution in people under 35 or over 65.
Why it matters
Most advanced fibrosis in fatty liver is missed in clinics that see the patient for something else.
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