What does the FibroSure NASH test assess for hepatic steatosis?

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Last updated: October 8, 2026 • View editorial policy

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What FibroSure NASH Test Determines for Hepatic Steatosis

FibroSure NASH (also known as FibroTest) is a proprietary serum biomarker test that primarily assesses hepatic fibrosis, not steatosis—it evaluates the degree of liver scarring in patients with NAFLD/MASLD, with a cutoff of <0.48 recommended to rule out advanced fibrosis 1.

Key Points About FibroSure NASH

What It Actually Measures

FibroSure NASH is designed to detect:

  • Hepatic fibrosis stage (liver scarring)
  • Risk of "at-risk" NASH with F2 or higher fibrosis 2

The test does not directly measure hepatic steatosis (fat content in the liver). This is a critical distinction that clinicians must understand.

Clinical Application in NAFLD/MASLD

According to current guidelines 1:

  • For ruling out advanced fibrosis: FibroTest®/FibroSure <0.48 is recommended as a validated threshold
  • As a secondary assessment tool: When elastography is unavailable, FibroSure can serve as an alternative serum-based fibrosis marker 2
  • Not first-line: FIB-4 score is preferred initially due to simplicity and cost, with FibroSure reserved for patients with indeterminate FIB-4 results (1.3-2.67) 2, 1

What to Use for Steatosis Assessment Instead

If you need to evaluate hepatic steatosis specifically, the guidelines recommend 1:

  • Imaging modalities:

    • MRI-PDFF (most accurate, reference standard for fat quantification)
    • CAP (Controlled Attenuation Parameter) via FibroScan (cutoff >275 dB/m has >90% sensitivity for detecting steatosis)
    • Standard ultrasound (first-line, despite limitations)

  • Serum scores are NOT recommended for diagnosing steatosis in clinical practice 1

Clinical Context from Research

One study 3 evaluated FibroSure NASH in psoriasis patients on methotrexate and found:

  • 78.3% had elevated steatosis scores at baseline
  • The test includes a steatosis component, but this is not its validated primary function
  • The fibrosis score correlated with cumulative methotrexate dose in women

Important caveat: While FibroSure NASH may report a steatosis component, this has not been validated or endorsed by major guidelines for clinical decision-making regarding hepatic fat content 1.

Recommended Clinical Algorithm

For patients with suspected NAFLD/MASLD:

  1. Calculate FIB-4 score first (age, AST, ALT, platelets)
  2. If FIB-4 <1.3: Advanced fibrosis ruled out
  3. If FIB-4 1.3-2.67 (indeterminate): Proceed to second-line testing
    • Elastography (FibroScan LSM <8 kPa rules out advanced fibrosis) OR
    • FibroSure/FibroTest <0.48 OR
    • ELF <9.8
  4. For steatosis quantification: Use CAP or MRI-PDFF, not serum biomarkers

The bottom line: FibroSure NASH is a fibrosis assessment tool validated for ruling out advanced liver scarring, not a steatosis diagnostic test. Use imaging-based methods (CAP, MRI-PDFF) when you need to quantify liver fat content.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.