Fib-4 score 0.66

[SShally]

Hello Everyone, please advise if fib-4 score is same as fibro scan score. Mine is 0.66 or 1 32. I am worried sick about it. It says the score is intermediate. I think I have terry nails, itching and dull pain. Is this mean that I have advanced cirrhosis? My blood test are normal.

[AyrshireK]

Fib-4 is a calculation based on Age, AST, ALT and platelets - the National Institute for Care Excellence (NICE) states:- "Fibrosis (FIB)-4 Score (FIB-4) — a score of greater than 2.67 suggests advanced liver fibrosis." So your 0.66 doesn't indicate cirrhosis at all based on that.

The symptoms you believe might be cirrhosis related i.e. itching, Terry's Nails etc. wouldn't arise if your bloods are normal (itching in advanced cirrhosis is usually due to a rise in your bilirubin levels/bile acids).

Terry's Nails can be circulation related and nothing to do with liver disease at all so are no longer used in the diagnosis of liver disease and a dull pain (I hate to say it) can be down to you focussing on it and it's possible it's a phantom pain or psychosomatic.

Most folks with advanced liver disease experience no pain in the liver area since the liver itself has no pain receptors - pain can occur when the liver is inflamed/enlarged and this is usually due to an irritation of the Glisson's Capsule in which the liver is contained. Again if your bloods are normal this isn't likely to be the scenario in your case.

Katie

[SShally in reply to AyrshireK]

Hi Katie, thanks once again for being helpful. Honestly, you have been most helpful to me than my GP so far. I thank you for being so kind. I think I am going mad. I can't stay focused. I don't know alot about cirrhosis and reading about it make me certain I have it. I am tearful most of the time. I have received a text from surgery if i think waiting time is too long, i can go for private option. Which didn't sound very fair. Looking for private fibro scan options (they aren't cheap). I understand that i may be panicking too much, but, i have no diagnosis and i dont know what i am doing so dar is right or not.

[AyrshireK in reply to SShally]

A fibroscan might not be the best or most accurate test in light of you reporting that your BMI puts you in the obese range. You have a diagnosis of fatty liver which is what you need to focus on and to try to get your body weight down. The only thing which will stop your condition getting worse is to deal with the fatty liver - even if you do have fibrosis it's the only thing that can help slow, stop or reverse any damage.

The NICE guidelines for NAFLD assessment state that in your situation with such a low Fib-4 your would be monitored in primary care rather than needing a hepatology referral. cks.nice.org.uk/topics/non-...

Keep on with your weight loss and exercise regime. I take it you have seen the BLT booklet on Treating Fatty Liver Disease with healthy diet and exercise?

britishlivertrust.org.uk/do...

Katie

[SShally in reply to AyrshireK]

Yes, I have seen BLT booklet. I have lost nearly 8 kg since January. No sugar, low salt, 1tbspoon exta virgin olive oil, fresh fruits, veggies and complex carb diet. I am trying to do 1 hour excersise every day. Please do let me know if I can add something to the list. I do crave coffee with milk some time

[AyrshireK in reply to SShally]

What's to stop you having some milk in a coffee? Coffee is supposed to be excellent for the liver and in BLT leaflet i've just provided the link to it actually says "Have some dairy or dairy alternatives (such as soya drinks). Choose lower fat and lower sugar options such as semi skimmed milk and Greek or natural yoghurt." And "Drink six to eight cups or glasses of fluid a day. Water, lower fat milk, and sugar free drinks including tea and coffee are all healthier choices."

Also in the section about your shopping list it states "Buy lower fat versions of dairy products like cheese, yoghurt and milk. There is as much calcium (needed for healthy teeth and bones) in skimmed and semi-skimmed milk as in full-cream milk."

[SShally in reply to AyrshireK]

Thanks, you have been very helpful. Thanks alot once again.

[SShally in reply to AyrshireK]

Hi Katie, I hope you are well. I don't want to sound like a broken record but I can really use your help. My nafald score is 1.32 (fib-4 0.66). I don't have any other symptoms accept itching and pain in upper right quadrant of abdomen. A study says pain only comes when fibrosis progress to crrihosis. It that true? Or you can pain with severe fatty liver without scarring too?

[AyrshireK in reply to SShally]

It's only my opinion but you are more likely to get pain in liver area when it is inflamed/enlarged (engorged by fatty build up) rather than when it is scarred and cirrhotic. The reasoning being that the liver itself has no pain receptors so technically you can't get liver pain. What you can get when liver us enlarged is a stretching of the Glisson's Capsule which surrounds the liver and potentially a compression of other abdominal organs - a cirrhotic liver tends to be smaller and more shrunken. Your fib-4 score rules out advanced fibrosis as previously discussed.

My hubby has never had liver pain despite living with cirrhosis for 12+ years. He might get a stitch like niggle when he's stressed but that's it.

Katie

[SShally in reply to AyrshireK]

Thanks alot Katie. I am worried sick. I am sorry to keep bothering you.

[BritishLiverTrust8 Moderator British Liver Trust]

Dear SShally

If you would find it useful to talk things over, our nurse-led helpline is open Monday to Friday from 9am to 3pm on 0800 652 7330 (excluding bank holidays)

Best wishes

British Liver Trust

[MINTVCX]

Please note about Fib-4:

"Use with caution in patients <35 or >65 years old, as the score has been shown to be less reliable in these patients"