How fast can f2 fibrosis progress f4 cirrhosis?

Hello. I have another question; hoping someone can enlighten me. In 2019, F2 fibrosis with severe steatosis was diagnosed. Fast-forward to December 2021 and a fibroscan showed F4 cirrhosis. Can the liver degenerate that quickly? Either the initial 2019 assessment was underreporting or the December 2021 fibroscan overestimated is how I'm interpreting this. My blood labs are within the normal range and no symptoms of liver disease currently showing, so what gives with the F4 cirrhosis determination the fibroscan spit out? BTW ... the fibroscans were administered and interpreted by two different liver specialists.

[AyrshireK]

What were your bloods doing when you had that first fibroscan showing the F2 with severe steatosis? In the interim have your inflammation markers - ALT, AST, GGT etc. been elevated? i.e. have you had steoto hepatitis or NASH?I know you've lost weight and been improving your fitness but if you have had hepatitis/inflamed liver then it could indeed have progressed.

Fibroscan is limited as a tool when used alone, I personally think you need further tests - either something like a CT scan, ultrasound (minimum) and even potentially a liver biopsy as your liver deteriorating (if it has) in that space of time needs more investigation.

Katie

[Hidden in reply to AyrshireK]

My bloodwork was seemingly in the normal range as well in 2019. Elevated enzymes but nothing else noted. After not hearing back from initial liver specialist and COVID during past two years, I decided to have a fibroscan at another clinic. Hence, the F4 cirrhosis diagnosis. I had an ultrasound done in December 2021 on spleen, gallbladder, liver and stomach. Report came back as negative on any other ailments (except for a gallstone) and “well defined liver functions” (that’s quoted directly from report). No mention of cirrhosis from the ultrasound.

[AyrshireK in reply to Hidden]

Sounds like you need to get a full work up done just to get it all tied up with so many clashing reports. Good news is you are symptom free so hopefully you'll get the situation clarified.

Katie

[DavyGravy]

Do you mean F4 Cirrhosis? or progressed to F4 Fibrosis? I know it is easy to get mixed up when we hear F4

Dave

[Hidden in reply to DavyGravy]

Hi Davy. The first scan (2019) indicated f2 fibrosis; second scan (2021) indicated f4 cirrhosis- I suppose aka f4 fibrosis?

[DavyGravy]

The scale goes F1 fibrosis to F4 Fibrosis then F4 fibrosis deteriorates to F1 cirrhosis, then all the way to F4 cirrhosis.

F1 Fibrosis slightly damaged

F2 Fibrosis

F3 Fibrosis

F4 Fibrosis mid damaged probably reversible

F1 Cirrhosis possibly still reversible

F2 Cirrhosis

F3 Cirrhosis

F4 Cirrhosis very seriously damaged

That's why I asked if it was F4 Fibrosis

[Hidden in reply to DavyGravy]

Davy, my December fibroscan printout read as F4 Cirrhosis but well-compensated and asymptomatic with normal blood labs. Could it be that in Canada the rating is different and instead of using F4 Cirrhosis, the term we should use is F4 Fibrosis?

It’s all so confusing. I also had full abdominal ultrasound with all normal and and endoscopy all normal. I was told I was in early stage cirrhosis but in reality I’m still in F2 Fibrosis as initially diagnosed in 2019?

[AyrshireK in reply to Hidden]

Not quite sure what scale that is Davy is referring to and it's potentially going to add to confusion.

The Metavir Scale reads F0 - F4

F0 - no fibrosis, normal liver

F1 - mild fibrosis

F2 - Moderate fibrosis

F3 - Severe fibrosis with bridging (also sometimes known as incomplete cirrhosis)

F4 - Cirrhosis

Cirrhosis can then be staged - dependent on symptoms present. Cirrhosis at any stage is still F4 fibrosis.

Stage 1 - Compensated with no varices, no ascites

Stage 2 - Compensated Varice, but no ascites

Stage 3 - Decompensated - Ascites, +/- Varices

Stage 4 - Decompensated - Bleeding, +/- Ascites

All stages up to F3 can potentially be fully reversed and even early F4 can be improved (to a degree or at lease stopped from progressing once the cause of any damage is identfied and treated).

Katie

[Hidden in reply to AyrshireK]

Thanks to all who responded. I’ve discovered it’s hard to zero in on a definitive diagnosis in my case. Spoken with three doctors and two of the three expressed more optimism than the one who assessed me in December. Regardless, my liver is functioning well despite the years of NA fatty abuse it’s taken and I’m extremely grateful. I’ll be kinder and gentler now that I’ve had the wake-up call and hopefully not too late.

[Dplat in reply to Hidden]

Hi , I had fatty liver for years. (From being over weight and eating unhealthy) I was having weight loss surgery and blood work done . My liver enzymes were really high . So during surgery they did a liver biopsy ,and it came back advanced fibrosis , beginning cirrhosis ( I have a little bit of scarring) . I have lost 93 pounds and now after blood work my liver is at F0-F1 . So it can deffinetly reverse !! I hope this makes you feel better

[Hidden in reply to Dplat]

Thank you Dplat. Your response is inspirational. I’m hoping that’s my situation too. I’m hopeful this was my wake-up call and none too late.

[currydog in reply to Dplat]

HI hun i haveF3 fibrosis and ggt of 380 dont no why realy .l dont drink i am a little overweight have appointment next week

[KC108 in reply to DavyGravy]

Are you sure about this information? I have never heard of this scale. I have seen F0,F1,F2,F3 and F4 fibrosis, with F 4 being Cirrhosis and then you are either compensated or decompensated.

[DavyGravy in reply to KC108]

Sorry I got confused by this

liver damage chart

[DavyGravy]

The terminology will be the same wherever we are but as Katie said, there seems to be conflicting results, the first scan put you on the second step up the ladder in Fibrosis.Your ultrasound shows gallstones and the next fibroscan shows you've jumped from one end of the scale right to the top of liver damage.

It is very possible that someone can go from early fibrosis to end stage liver disease very quickly but I assume that usually there would be an underlying cause (autoimmune or something that rapidly damages the liver quickly)

I would only suggest a biopsy if there was no alternative to getting a definite diagnosis, but, it is something you might discuss with your doctor if there is no other way to figure out which of these scans is correct.

wishing you well

Dave

[Hidden in reply to DavyGravy]

Thank you for taking the time, Davy. I will need to follow up and insist on clarity. I’m going to assume for now that if liver rating terminologies are universal, what was meant was the zone between F4 Fibrosis and Cirrhosis. Thanks again.

[DavyGravy]

Oh I see, so on the cusp of F4 fibrosis and F1 cirrhosis

[Nalabanana]

Hi Quas ,I had a fibroscan in 2021 i was f2 i had a repeat scan this year and im f3 ,bloods last year all up and down this year they are within range i was told ,so i dont think theres a time limit on how things progress ,i dont have a drink problem or any other problems just this ,so ive an appointment with consultant in early april to see whats next, they had said in my letter about a biospy so il wait and see ,hope you can get some answers to your question ..

[Readlots]

Hi Quas, I’m not sure you’ll ever get an answer to the ‘how fast?’ question. Livers are notoriously unpredictable! But always good to ask as many questions as you need to.

[MINTVCX]

Can I ask what was your kpa score?

[Hidden in reply to MINTVCX]

Sure the kpa was 17.8 but I’m uncertain if that’s accurate as I read the proper probe needs to be used. In my case, the M probe was applied but perhaps the XL would’ve yielded a more definitive result(?)

[MINTVCX in reply to Hidden]

Yep according to some articles high BMI (above 30) can cause fibroscan less accurate. How much it is hard to say. I am not an expert but progress from F2 to F4 within 2 years is not typical regarding NAFLD only. You have to check this with your hepatologist. Maybe some more specific tests from blood? I mean ELF or fibrotest?

[Hidden in reply to MINTVCX]

Thank you, Mint. I’m trying to push hard for answers or a definitive diagnosis but usually end up more mystified.

[motherconfessor]

Hi. I was diagnosed with NAFLD in 2019 following my annual blood tests. Then in mid 2021 my annual blood tests were worse so GP ordered further tests, diagnosed with type two diabetes in November 2021 and just before Christmas 2021 was informed I had cirrhosis. So it was very quick for me. I haven't touched alcohol since becoming pregnant in 1995, but am overweight and underactive, trying to address both of these. Have been on lots of medication for years so don't know if that's had an impact. Just been lurking on here trying to learn what I can.