Non-alcoholic Fatty Liver Disease (NAFLD or NASH) and fibroscan results.
Has anyone come across scale that diagnosed F4 (cirrhosis) based on fibroscan result below 11 kPa? (NAFLD or NASH)
I found this for example:
Non-alcoholic Fatty Liver Disease (NAFLD or NASH) 2 to 7 kPa F0 to F1 Is normal.
7.5 to 10 kPa F2 Has moderate scarring.
10 to 14 kPa F3 Has severe scarring.
14 kPa or higher F4 Has cirrhosis.
Echosans (producer of fibroscan) has a Fibroscan score chart has a bar for NAFLD where cirrhosis occurs around the 11.5 kPa mark.
Hi Katie, does the FIB 4 calculation also correlate differently based on etiology? E.g. alcohol induced fibrosis ?
Thank you
If I can answer. About Fib-4 origin:
"Noninvasive estimate of liver scarring in HCV and HBV patients, to assess need for biopsy."
However:
"The FIB-4 Index was shown to be superior to 7 other noninvasive markers of fibrosis in patients with NAFLD, including the NAFLD Fibrosis Score"
Also I found
"Patients with any known risk factors for liver disease, including chronic hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD) and the cholestatic and metabolic liver diseases"
It doesn't look like Fib-4 has different ranges for different conditions though i've got to say i've no experience with Fib-4. Some information I found on line.
The FIB4 index was developed in 2006 by Sterling as a non-invasive method to diagnose liver fibrosis and combines aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, platelet count, and age.
The index was originally used for staging liver fibrosis in HCV patients with HIV and, thereafter, has been used to quantify fibrosis of various liver diseases, including HCV (Hepatitis C virus) or HBV (Hepatitis B virus) infection, alcoholic liver disease, and non-alcoholic fatty liver disease. As the FIB4 index is calculated using only clinical laboratory test values and age, it is a completely objective evaluation, similar to the ALBI score. Moreover, the FIB4 index uses no numerical values directly correlated with liver synthetic ability or metabolic ability, such as albumin, total bilirubin, and prothrombin levels; therefore, not a single variable in this index overlaps with those in the ALBI and Child–Pugh scores. Another advantage of the FIB4 index is that it does not include the variables used in conventional integrated scores, which tend to vary with other factors.
Fibrosis-4 (FIB4) Scoring System for Liver Fibrosis
The FIB4 index is an indicator of hepatic fibrosis calculated on the basis of age, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, and platelet count, but it does not include variables directly related to liver function.
FIB4 = Age x AST / (Platelet x sqr(ALT))
Age in years old, AST in U/L (Norm: 15 – 41), Platelet count in 10³/µL (Norm: 150 – 350 × 10³/µL), ALT in Norm: 1 – 35 U/L (Norm: 1 – 35 U/L).
The diagnostic cut-off values of the FIB 4 index produce a negative predictive value of 94.7% with a sensitivity of 73.4%, and a positive predictive value of 82.1% with a specificity of 98.2%.
Interpretation of FIB-4
Points < 1.45: Cirrhosis less likely
Points ≥ 1.45 and ≤ 3.25: Indeterminate
Points > 3.25: Cirrhosis most likely
Abbreviations: sqr, square root
Regarding this part:"The diagnostic cut-off values of the FIB 4 index produce a negative predictive value of 94.7% with a sensitivity of 73.4%, and a positive predictive value of 82.1% with a specificity of 98.2%"
In other words Fib-4 is better to rule out cirrhosis (also F3) than to detect (confirm) it - in that case further tests are needed. But Fib-4 is a good start point better than simple checking AST and ALT levels.
Here's my take on FIB-4 for what it's worth. I've always been puzzled by the value being inversely dependent on ALT. So the higher your ALT level, the lower your FIB-4 score, which is counter-intuitive to a layman like me. Mine came out at 2.2 despite all my levels (apart from age!!) being well within the normal range. 2 was given as the cutoff value for cirrhosis being unlikely, although my own calculation produced a value of 1.9. No wonder test results often cause confusion. 🤷
Regarding"So the higher your ALT level, the lower your FIB-4 score, which is counter-intuitive to a layman like"
Not exactly true. You get higher score when AST/ALT > 1.
Let's assemu you have AST = 30 (platelet count, age the same, example results)
For ALT = 20 you get FIB-4 = 1.27 (200, 38)
For ALT = 40 you get FIB-4 = 0.90 (200, 38)
About age there is also this remark:
"Use with caution in patients <35 or >65 years old, as the score has been shown to be less reliable in these patients"
I believe you just proved my point. Perhaps I should have been more specific and said that, all other things being equal, a higher ALT level results in a lower FIB-4 score. Obviously the other numbers can be manipulated to give any score you want for any ALT level.Anyway, my point is that, at least where FIB-4 is concerned, high age=bad; high AST=bad; low platelets=bad; high ALT=good. All make sense to me except for the last one.
I would just assume you have cirrhosis. Whether or not you do you should change your lifestyle for the better. I stopped drinking , better diet and started to exercise . I feel so much healthier and I still have cirrhosis.
fibroscan reliability
Nash and fibroscan 
Some Good News
