Fibrosis 4 Score of 0.51

[Calvincat]

I'm being referred to a hepatologist, due to abnormal ALT levels and notice on the referral letter the above, could someone briefly tell me what this means? I understand as per the community guidelines that having info like this isn't to be analysed, so just a snippet of what this means would be appreciated.

[Hidden]

I'm guessing this refers to the "FIB-4" algorithm of age & blood tests as an indicator of liver disease.

The FIB-4 index was developed as a noninvasive panel to stage liver disease. It relies on the age, AST, ALT and platelet count. ( Age x AST ) / ( Platelts x ( sqr ( ALT )

There are different result / scales used for Hep-C & NASH.

Hope this helps.

[Calvincat]

So is that good or bad you reckon? I’m going to ask about it, so just doing my homework first if you like...

[Hidden in reply to Calvincat]

According to the calculators in the following links it appears to be really good assuming that the 0.51 score was obtained using the "FIB-4" algorithm that Metanoia referred to. You could enter your own blood test scores in the first calculator to see if you get 0.51. Mine was 2.52 due to a low platelet count & slightly raised ALT. The result was 'Further investigation needed' & I've had that & nothing was found.

mdcalc.com/fibrosis-4-fib-4...

hepatitisc.uw.edu/page/clin...

The calculators allow you to enter blood test values, age, BMI etc. & get a score for likelihood that you have NAFLD and/or fibrosis. They confirm that I'm in a grey area. I have no fatty liver or fibrosis that shows up on scans but I have probable early NASH which I'm doing every possible to address.

I question some of the 'normal' range values. In one of the calculators the normal range for ALT is 1-35. The 35 upper limit is too low for a male. It should be 40. In the USA it's 45 possibly due to so many people being overweight & having fatty livers that they changed the normal range values to hide the epidemic of fatty & mildly inflamed livers to ease the burden on the health system!

[Calvincat in reply to Hidden]

Hey Edward, just used those calculators and it came to the above score - however, the platelet count (263 10*9) was from a blood test in Feb 2018, AST (29) was from Jan 2017 & ALT (72) from Dec 2018. Will just have to wait and see what's said with the hepatology people...

[Hidden in reply to Calvincat]

Given your excellent score your liver is probably structurally in very good shape however something must be irritating it to raise the ALT. You have a good GP if you are being sent to a hepatologist solely because of a raised ALT. I'd try looking for anything I'd done to raise the ALT e.g. drinking a lot of alcohol, taking painkillers or prescribed medication etc. If none of these apply then the hepatologist will look at other less likely reasons for a raised ALT.

[Calvincat in reply to Hidden]

ALT has been raised the last few years and it's only now they're doing something to see what's going on, had an ultrasound two years ago this month as it happens and they just said the liver was mildly inflamed. In the last year I started taking Sertraline, only use painkillers when necessary, I'm a light drinker, though wasn't up until about 4 years ago. It's all a bit of a mystery..

[Hidden in reply to Calvincat]

You really shouldn't be drinking at all if taking Sertraline. The sertraline alone might be raising ALT. You could be like me. I took painkillers & drank moderately for 35 years & had normal blood tests apart from mildly raised ferritin. Six or seven years ago odd blood test values started to appear slightly out of normal range and my GP made light of them. Three years ago my platelet count started to fluctuate between normal & low. Finally ALT rose above normal. My liver was telling me that I needed to clean up my lifestyle.

I stopped drinking alcohol 3 years & 4 months ago & taking painkillers 18 months ago but my blood tests continue to show that my liver function remains slightly impaired meaning that I may have NASH. My GP should have told me that the abnormal blood test values were early warning signs that my liver was starting to struggle.

Your liver may be telling you the same thing. You could get away with ignoring the raised ALT for a time given that your liver appears to be in good shape structurally but it will eventually catch up with you unless addressed now. See what the hepatologist says but consider giving up alcohol while taking Sertraline. The hepatologist will almost certainly tell you to do that if you tell him that you drink. If you stop drinking & ALT remains raised he may take you off the Sertraline to see if it's causing the raised ALT.

[Calvincat in reply to Hidden]

It crossed my mind about the sertraline raising ALT, GP checked and seemed to think reactions would be rare when he consulted a medical manual, I looked it up too. When I do drink, I always stick a max of two units, as became very cautious about alcohol. I only touch the stuff a few times a week if at all these days, I’m happy to keep off it though.

[jak547 in reply to Calvincat]

if that is in fact your FIB-4 score, these are the scoring interpretations

FIB-4 ScoreDiagnosis

<1.3Advanced fibrosis excluded

1.3-2.67Further investigation needed

>2.67Advanced fibrosis likely

[LindaC in reply to jak547]

Hi - thank you - where do the above scores come from?

[Calvincat]

So... my LFT have been silly for the last 4 years, so as mentioned was evetually referred to see a hepatologist, I decided to go private as have health care insurance with work, and saw someone two weeks ago and had blood tests the same day and a CT scan a few days later, only heard back yesterday briefly from the specialist and he seems to think liver looks fine and inflammation maybe from my small bowel, so god knows what that CT has thrown up, he said not to worry (don't they all say that?!) and also some of the bloods haven't come back, going back to the Nuffield to see him next week anyway...