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FIB-4 index to rule-out advanced liver fibrosis in NAFLD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The FIB-4 index incorporates routinely available clinical data including age, AST, platelet count (PLT), and ALT level according to Sterling’s formula as follows:

[Age (years)×AST (IU/L)]/[PLT (10 9/L)×ALT 1/2 (IU/L)]


online FIB-4 calculator - click here

  • the scoring system creates a score - <1.45 has a negative predictive value of over 90% for advanced liver fibrosis of multiple aetiologies (1)(2)
  • a score of >3.25 has a positive predictive value of 65% for advanced fibrosis with a specificity of 97%
  • it has been suggested (3):
    • A FIB-4 index<1.45 in a context of fatty liver disease excludes clinically significant hepatic fibrosis
    • additional explorations are mandatory to excluded hepatic fibrosis for a a FIB-4 index>1.45 in a context of fatty liver disease
    • a complete hepatological workup is mandatory for a FIB-4 index>3.25 in a context of fatty liver disease


  • 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
  • McPherson S, Stewart SF, Henderson E et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut 2010;59:1265–9 doi:10.1136/gut.2010.216077
  • Mallett V et al.FIB-4 index to rule-out advanced liver fibrosis in NAFLD patients. Presse Med 2019 Dec;48(12):1484-1488.

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