What does a Fibrosis‑4 (Fib‑4) score of 1.14 indicate about the likelihood of advanced liver fibrosis?

FIB-4 Score of 1.14: Interpretation and Clinical Implications

A FIB-4 score of 1.14 reliably excludes advanced liver fibrosis and indicates low risk, requiring no immediate specialist referral but warranting lifestyle modifications and repeat testing in 2-3 years. 1

Risk Stratification

Your score falls well below the low-risk threshold of 1.3 (or 2.0 if age ≥65 years), which has a negative predictive value exceeding 90% for excluding advanced fibrosis (stages F3-F4). 1 This means there is less than a 10% chance of having significant liver scarring. 2

The established FIB-4 interpretation zones are:

• Low risk: <1.3 (your score of 1.14 falls here) 1, 2
• Indeterminate: 1.3-2.67 1, 2
• High risk: >2.67 1, 2

Immediate Management Recommendations

No hepatology referral is needed at this time. 2 Your low score indicates you can remain in primary care with appropriate monitoring. 2

Lifestyle Interventions (Critical Even with Low Score)

Implement aggressive metabolic risk factor management regardless of your reassuring FIB-4:

• Target 7-10% weight loss if overweight or obese, as this improves fibrosis with a dose-response relationship 3, 4
• Exercise 150-300 minutes weekly of moderate-intensity activity (or 75-150 minutes of vigorous activity) 3, 4
• Mediterranean diet pattern: daily vegetables, fresh fruit, fiber-rich cereals, nuts, fish/white meat, olive oil; minimize simple sugars and red/processed meats 4
• Complete alcohol abstinence or minimal consumption 2

Metabolic Risk Management

Address all components of metabolic syndrome aggressively:

• Optimize glycemic control if diabetic (target HbA1c <7%) 2
• Treat hypertension to <130/80 mmHg 2
• Manage dyslipidemia with statins as indicated (statins are safe in liver disease) 3, 4

Surveillance Timeline

Repeat FIB-4 testing in 2-3 years while continuing lifestyle modifications. 1, 2 The interval depends on your metabolic risk profile:

• Without diabetes or multiple metabolic risk factors: Repeat in 3 years 2
• With prediabetes, type 2 diabetes, or ≥2 metabolic syndrome features: Consider repeat in 2 years or earlier 2

When to Escalate Despite Low FIB-4

Consider secondary testing with vibration-controlled transient elastography (VCTE/FibroScan) or Enhanced Liver Fibrosis (ELF) testing if any of the following develop:

• Persistent ALT elevation >2× upper limit of normal (>40 U/L for women, >60 U/L for men) despite lifestyle modifications 2
• Declining serum albumin below normal range with adequate nutrition 2
• Clinical features suggesting advanced disease: splenomegaly, thrombocytopenia (<150,000/μL), or stigmata of chronic liver disease on examination 2
• Type 2 diabetes with poor control (HbA1c >8%) or multiple metabolic comorbidities 2
• FIB-4 rises to ≥1.3 (or ≥2.0 if age ≥65) on repeat testing 2

Important Caveats

Age-specific considerations: If you are ≥65 years old, the low-risk cutoff is <2.0 rather than <1.3, so your score of 1.14 remains reassuringly low. 1, 2 FIB-4 has reduced accuracy in patients <35 years due to age-dependent calculations. 3, 2

Do not pursue invasive testing (liver biopsy) or specialist referral based solely on imaging findings (such as "coarsened liver echotexture" on ultrasound) when FIB-4 is reassuringly low, as ultrasound findings of steatosis do not correlate with fibrosis stage. 2

Prognostic Context

While your current risk is low, understand that fibrosis stage is the strongest predictor of future liver-related outcomes, including hepatocellular carcinoma, liver decompensation, transplantation, and death. 3, 2 Maintaining a low FIB-4 through lifestyle modifications is critical for long-term liver health. 5

Cardiovascular disease remains the main driver of morbidity and mortality in early-stage liver disease before cirrhosis develops, making aggressive cardiovascular risk management essential even with a low FIB-4. 3, 4