FIB-4 includes age in its formula, so it rises with age regardless of fibrosis. Above 65, the usual low-risk cut-off of 1.3 flags too many people; a cut-off of 2.0 is commonly used instead. Below 35, the score is unreliable and can miss significant fibrosis.
It also relies on transaminases and platelets, so anything that lowers platelets — hypersplenism from another cause, a marrow problem, recent infection — can raise the score falsely.
- Use a low-risk FIB-4 cut-off of 2.0 rather than 1.3 in patients over 65
- Do not rely on FIB-4 in patients under 35
- Check the platelet count makes sense before trusting a high score
- Confirm an indeterminate score with elastography where available
Why it matters
Without the age correction, FIB-4 sends many healthy older patients for unnecessary tests.
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