From the Guidelines
A FIB-4 score of 1.3 or higher is considered indicative of advanced fibrosis in a 60-year-old patient. The management plan for such a patient should prioritize confirming the diagnosis with additional testing, such as transient elastography (FibroScan) or liver biopsy, as recommended by the EASL clinical practice guidelines 1.
Key Considerations
- The FIB-4 score is a non-patented test that uses a combination of age, AST, ALT, and platelet count to assess liver fibrosis, with a score of 1.3 or higher indicating advanced fibrosis 1.
- For patients with a FIB-4 score above 1.3, the use of transient elastography (TE) and/or patented serum tests should be considered to rule out or confirm advanced fibrosis 1.
- The EASL-EASD-EASO clinical practice guidelines recommend a stepwise approach using blood-based scores, such as the FIB-4 index, and imaging techniques, like transient elastography, to rule out or confirm advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) 1.
Management Approach
- Patients with advanced fibrosis should be referred to a hepatologist or gastroenterologist for comprehensive evaluation and management.
- Regular surveillance for hepatocellular carcinoma should be implemented with ultrasound examinations every 6 months, with or without alpha-fetoprotein testing.
- Endoscopic screening for esophageal varices is also recommended to assess for portal hypertension complications.
- The underlying cause of liver disease must be addressed, and medications that may worsen liver function should be avoided.
- Vaccinations against hepatitis A, hepatitis B, pneumococcus, and influenza should be administered, and regular monitoring of liver function tests every 3-6 months is essential to track disease progression 1.
From the Research
Threshold Fib4 Score for Fibroscan in 60-year-old
- The Fib4 score is used to assess liver fibrosis, and its threshold values vary by age group 2.
- For a 60-year-old, the modified low and high cutoff points for the FIB-4 index are 1.88 and 2.67, respectively 2.
- These cutoff points can help improve the accuracy of advanced fibrosis diagnosis in non-alcoholic fatty liver disease (NAFLD) patients.
- It's essential to note that the FIB-4 index is just one tool used to assess liver fibrosis, and other tests like the Enhanced Liver Fibrosis (ELF) test may also be used in conjunction with FIB-4 to estimate advanced fibrosis 3, 4.
Management Plan for Advanced Fibrosis
- Lifestyle modifications, such as weight loss, exercise, and a healthy diet, are the basis for prevention and treatment of NAFLD-associated fibrosis 5.
- Investigational drugs targeting metabolic pathways, insulin resistance, and inflammatory cell recruitment may also be used to treat liver fibrosis 5.
- A sequential test strategy of FIB-4 followed by the ELF test in indeterminate cases can help reduce futile referrals and detect advanced fibrosis cases 3.
- The combination of an ELF score and a FIB-4 score can be used to rule out or rule in advanced fibrosis, with a negative predictive value of 95.1% and a positive predictive value of 95.0%, respectively 4.