g. 2023;38 (2):277–81. A new equation to estimate glomerular filtration rate. Hepatic complications of NAFLD include progressive liver disease leading to cirrhosis and liver failure and the development of hepatocellular carcinoma which is largely confined to those with advanced fibrosis and Jun 15, 2017 · Clinical Question Which patients with nonalcoholic fatty liver disease (NAFLD) have a low likelihood of fibrosis or cirrhosis? This fibrosis 4 (FIB4) score calculator evaluates liver fibrosis based on age, platelet count, AST and ALT to help with cirrhosis diagnosis. 67 were classified as having advanced fibrosis. The NAFLD Activity Score assesses histological injury of patients with NAFLD. Jul 27, 2025 · The NAFLD Fibrosis Score is calculated using six distinct variables, each offering insights into liver health and potential fibrosis progression. This is a health tool that assesses the level of fibrosis, scarring of the liver, consistent with the existence of nonalcoholic fatty liver disease (NAFLD). Fibrosis means scarring of the liver. The severe form is called nonalcoholic steatohepatitis. 3 - 2. To compare the performance of the FIB4 index (based on age, aspartate and alanine aminotransferase and platelet ADVICE Enhanced Liver Fibrosis (ELF) Score should be considered for the assessment of advanced liver fibrosis in patients with NAFLD. NAFLD Fibrosis Score - The NAFLD fibrosis score is a simple noninvasive approach to identify patients that may have significant liver fibrosis and who therefore might benefit from additional studies such as elastography or liver biopsy. An ELF Score ≥10. It will appear in the oval on the far right (highlighted in yellow). ELF Score ≥10. 6 For patients in high-risk groups with an indeterminate or high fibrosis-4 (FIB-4) index, the Enhanced Liver Fibrosis Score, or ELFTM Score, is a recommended option. 7–10 ELF is included as a Do not use routine liver blood tests to rule out NAFLD — be aware that liver blood tests and liver ultrasound appearances may be normal in people with NAFLD and do not necessarily reflect the stage of disease. Jan 1, 2023 · Thus, the aim was to determine the NAFLD Fibrosis Score (NFS) and the Fibrosis-4 Score (FIB-4) cut-off points that best identify NAFLD patients at risk for developing liver fibrosis. Conclusions APRI allows screening of NAFLD as well as fibrosis in obese patients. Aims To describe the distribution of the biomarker scores Fibrosis‐4 (FIB4), nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index The NAFLD fibrosis score calculator identifies liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). The risk of cardiovascular disease should be assessed using a validated tool. The risk of advanced liver fibrosis should be assessed using a non-invasive scoring system, such as the NAFLD Fibrosis Score (NFS), Fibrosis (FIB)-4 score or the Enhanced Liver Fibrosis (ELF) test. Objective Liver biopsy is the most accurate method for determining stage and grade of injury in non-alcoholic fatty liver disease (NAFLD). If the ELF Score is <10. The evidence supports the routine adoption of a change to the Enhanced Liver Fibrosis (ELF) test score cut-off from 10. 8 to diagnose advanced fibrosis (AF) in people with metabolic dysfunction-associated steatotic liver disease (MASLD) in any healthcare setting. The exact prevalence is not known, but population studies from the USA and China using magnetic resonance spectroscopy estimate that approximately 30% of the general population have steatosis. Fibrosis-4 (FIB-4) Calculator Share The Fibrosis-4 score helps to estimate the amount of scarring in the liver. There is no evidence of benefit in frequent monitoring of LFTs in NAFLD where there is simple fatty liver with no evidence of fibrosis or cirrhosis. Reduce the need for liver biopsy by identifying patients with non-alcoholic fatty liver disease likely or unlikely to have advanced fibrosis The Fibrosis-4 (FIB-4) Index for Liver Fibrosis is a non-invasive scoring system based on several laboratory tests that help to estimate the amount of scarring in the liver. It relies on readily available clinical information and routinely measured laboratory data. 455), suggests advanced liver fibrosis. Currently there are no We would like to show you a description here but the site won’t allow us. 3 or higher suggests you may want further liver assessment There are several follow-up tests available, including measurements of liver stiffness, such as liver elastography (e. Because it’s based on simple blood tests, the fib 4 score offers a convenient, cost-effective, and evidence-based way to monitor your liver health and guide follow-up testing when needed. You can read more about the different names and what they mean below. 51 to 9. There is no known safe level of alcohol use for patients with NAFLD/NASH. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a long-lasting liver condition caused by having too much fat in the liver. NAFLD Fibrose Score The NAFLD Fibrosis Score is used to estimate the extent of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). 6 This is a newer Nov 15, 2020 · Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the United States, affecting up to 30% of adults. Many patients with NAFLD remain undiagnosed and recognizing those We would like to show you a description here but the site won’t allow us. For all testing indications, an elevated FIB-4 index is consistent with the presence of advanced fibrosis, whereas a low FIB-4 index is consistent with the absence of advanced fibrosis. 67: Indeterminate range requiring additional testing such as vibration-controlled transient elastography (FibroScan) or Enhanced Liver Fibrosis (ELF) testing 1, 2 FIB-4 >2. Ann Intern Med. Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of conditions associated with > 5% lipid deposition in the liver. Use our NAFLD Fibrosis Score Calculator to assess liver fibrosis risk, improve monitoring, and support better overall liver health. Endocrinol Metab (Seoul). NAFLD-FS is calculated using age, AST, ALT, platelet level, albumin level, presence of hyperglycemia, and Body Mass Index (BMI): all factors inversely related to severity of liver fibrosis in NAFLD Fibrosis Score (NFS) — an intermediate or high score (greater than minus 1. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score. For the specific task of diagnosing early-stage fibrosis, serum biomarker panels, particularly the ELFTM test, demonstrate better utility, with scores showing a clearer correlation with the progression from no fibrosis to early and significant fibrosis. 51, then advanced liver fibrosis is unlikely. 45 rule-out threshold. This allows the identification of advanced liver fibrosis without the need for a liver biopsy. 3 indicates a low risk for significant fibrosis A score of 1. 2009;150 (9):604–12 We would like to show you a description here but the site won’t allow us. It outlines the lifestyle changes and pharmacological treatments that can manage NAFLD and advanced liver fibrosis. The nonalcoholic fatty liver disease (NAFLD) Fibrosis Score (NFS) is a simple, serum-based index, originally developed for the diagnosis of advanced hepatic fibrosis in patients with NAFLD 8 – 11. The spectrum ranges from simple steatosis characterized by the innocuous presence of fat droplets in hepatocytes, to the more advanced form of nonalcoholic steatohepatitis (NASH), and the more progressive and severe Aug 17, 2023 · This diagnostic study of adults in Asia evaluates the performance of 2 index scores in estimating clinical outcomes for individuals with nonalcoholic fatty liver disease. Jan 7, 2026 · When it comes to AST and ALT, there’s a simple score that can help assess your risk for liver fibrosis or advanced disease, Dr. Jan 16, 2023 · The highest possible result is 75 kPa. Find out more about fibrosis. Given risks and limitations of biopsy, non-invasive tests such as NAFLD fibrosis score, aspartate transaminase Jan 9, 2026 · Performance of simple fibrosis score in non-alcoholic fatty liver disease with and without type 2 diabetes. There are several liver conditions that are defined under this term which includes steatosis which is or not accompanied by various degrees of inflammation and cannot be appointed to alcohol co Mar 28, 2025 · What is the progression of NAFLD to fibrosis? NAFLD includes both nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). 4 days ago · FIB-4 1. 3 were classified as not having advanced fibrosis, while patients with a FIB-4 score >2. 5 High risk for advanced liver fibrosis. Learn when it's used, how the score is calculated, and how to interpret results. The nonalcoholic fatty liver disease activity score (NAS) measures disease activity by considering grades of steatosis, lobular inflammation, and hepatocyte ballooning and ranges from 0 to 8. Depending on score and local prevalence of advanced fibrosis, the score can be used to reliably predict (with high 80-low 90% accuracy) which patients are unlikely to have cellular evidence of fibrosis on biopsy. The bottom line? 4 days ago · FibroScan (vibration-controlled transient elastography) is indicated as a second-line test after initial risk stratification with simple fibrosis scores (FIB-4 or NAFLD Fibrosis Score) in patients with suspected NASH who have obesity, diabetes, or metabolic syndrome, specifically when these initial scores fall in the indeterminate range or to Enhanced Liver Fibrosis (ELF) Score - The Enhanced Liver Fibrosis (ELF) score predicts progression to cirrhosis and liver-related events in patients with advanced fibrosis due to NASH. A simple blood test can help identify those at risk. 3-2. LFTs seem to have little predictive value for severity of liver disease or future mortality risk until late disease when the bilirubin rises or the albumin falls. Fibrosis scoring systems (FIB-4 and ELF) This page includes information about the ELF and Fib-4 fibrosis scoring systems. Your results can range from normal to advanced. Age is a factor, as the prevalence of NAFLD and its progression to fibrosis tend to increase with advancing years. Oct 28, 2022 · The 3-step approach may improve the diagnostic performance to predict advanced fibrosis in NAFLD, which could lower rates of referrals to specialists, liver biopsies, and medical costs. 67 suggests advanced liver fibrosis. Bansal adds. Free online tool for medical professionals. Twenty percent of patients with NAFLD progress to nonalcoholic steatohepatitis (NASH), which is strongly linked to liver fibrosis and can lead to cirrhosis, liver transplantation, or death. Using your liver stiffness result to find your fibrosis score Your healthcare provider will use your liver stiffness result and medical history to find out your fibrosis score. Bansal explains. 67 High risk for advanced liver fibrosis. Enter the required values to calculate the FIB-4 value. Whilst it is clear that NAFLD is common within the general population, this generally causes little in the way of morbidity or mortality. Please note: The use of the FIB-4 score is not validated where a patient is over 75 years of age. Nov 1, 2018 · The nonalcoholic fatty liver disease fibrosis score (NFS) is comprised of unique metabolic risk indicators that may accurately predict residual cardio… NAFLD Fibrosis Score Calculator Estimate the risk of liver fibrosis based on clinical and laboratory data FIB-4 Calculator for NAFLD NB This is only valid for non-alcoholic fatty liver disease (NAFLD) and is intended for use in conjunction with the NCL Abnormal LFT pathway. Treat metabolic risk factors and if there is ongoing risk suggest repeating test in 3 years. It is a spectrum of Calculate NAFLD (Non-Alcoholic Fatty Liver Disease) Fibrosis Score to assess liver fibrosis risk. 67 (Indeterminate) ELF <9. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Nov 18, 2020 · FIB-4 index helps rule out advanced liver fibrosis in NAFLD using age, AST, platelet count and ALT values with a <1. It is important to remember that the ranges in the table are estimates, and your actual fibrosis score may not match what the table says. The Enhanced Liver Fibrosis (ELF) Score is a noninvasive test that indicates whether a patient with NASH and advanced fibrosis has a higher or lower risk of disease progression to cirrhosis (for those with F3 fibrosis) or other liver-related clinical events (for those with F3 or F4 fibrosis) within 1 to 4 years. 6 were indeterminate, requiring further testing. 4. Patients with NAFLD should be assessed for alcohol use and be encouraged to abstain from alcohol We would like to show you a description here but the site won’t allow us. Non-alcoholic fatty liver disease (NAFLD) affects approximately 30% of adults in developed countries. Use a first-line non-invasive tool to assess the level of fibrosis, such as Fibrosis- 4 (FIB-4) or NAFLD Fibrosis Score (NFS). NAFLD has wide ranges of disease spectrum from nonalcoholic fatty liver, nonalcoholic steatohepatitis (NASH), and liver fibrosis, which can progress to cirrhosis and hepatocellular carcinoma. It is a stage of long-term liver disease. MASLD, NAFLD and fatty liver disease MASLD, NAFLD and fatty liver disease are different names for the same condition. NAFL typically advances by one stage every 14 years, and NASH progresses by one stage every 7 years. Fibrosis (FIB)-4 Score (FIB-4) — a score of greater than 2. ELF ≥9. A liver with fibrosis can still do all its usual jobs. 67: High probability of advanced fibrosis with approximately 60-80% positive predictive value—refer to hepatology for comprehensive evaluation 1, 2 Dec 30, 2025 · This patient most likely has non-alcoholic fatty liver disease (NAFLD) and should immediately begin a structured weight loss program targeting 7-10% body weight reduction through caloric restriction (500-1000 kcal/day deficit) combined with moderate-intensity exercise, while undergoing fibrosis risk stratification using FIB-4 or NAFLD Fibrosis 4 days ago · The coexistence of chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) accelerates liver fibrosis progression, but effective noninvasive tools for fibrosis risk assessment in this specific population are lacking. AIM: To study whether the severity of liver fibrosis estimated by the nonalcoholic fatty liver disease (NAFLD) fibrosis score can predict all-cause mortality, cardiac complications, and/or liver complications of patients with NAFLD over long-term Its strength lies in the assessment of more advanced disease stages. Your local guidance may differ. Sequential Algorithm for Fibrosis Evaluation (SAFE) in NAFLD Modified from: J Hepatol 2016; 64:1388-1402; J Hepatol 2019; 71:389-396; Am J Gastroenterol 2017;112:740-751 The Nonalcoholic fatty liver disease (NAFLD) Activity Score (NAS) has been applied as a method for evaluating treatment response, and a ≥2-point improvement in NAS has been commonly used as an accepted end point in phase 2b clinical trials in nonalcoholic steatohepatitis. “People with risk factors—such as obesity, high cholesterol, diabetes or prediabetes—can easily calculate their risk for liver fibrosis [the buildup of scar tissue in the liver] using a simple In Asia, the prevalence of NAFLD is as high as North America, which is thought to be due to the introduction of the Western diet. [4] Those with FIB-4 scores 1. Aug 23, 2022 · Doctors use the NAFLD fibrosis score to predict how much scarring there is in the liver. Liver fibrosis scores, including the NAFLD fibrosis score (NFS), Fibrosis-4 index (FIB-4), and Forns score, were used to assess the degree of liver fibrosis and, by extension, to reflect the severity of MASLD. 1 The disease encompasses a broad range of functionally distinct liver disorders. The NAFLD Fibrosis Score Calculator is a clinical tool that estimates the risk of advanced liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) using readily available clinical and laboratory data. Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of abnormal liver function tests (LFTs) in the UK with approximately a third of the population being affected. 51 suggests advanced liver fibrosis and is an indication for referral to a specialist in hepatology. Aug 26, 2013 · Nonalcoholic fatty liver disease (NAFLD) at large is relatively benign, but some individuals with NAFLD develop major hepatic and extrahepatic complications (NAFLD-at-risk). This NAFLD fibrosis score calculator determines the degree of hepatic fibrosis in patients with non-alcoholic fatty liver disease. The 2022 American Association of Clinical Endocrinology (AACE) guidelines recommend specialized blood tests and imaging to determine risk of significant fibrosis. But if the damage continues it can cause cirrhosis. Nonalcoholic fatty liver disease, or NAFLD, is a liver condition that is associated with obesity, diabetes, dyslipidemia, and hyperinsulinemia. The score has been developed for patients between 35 and 65 years of age. We would like to show you a description here but the site won’t allow us. Jul 6, 2016 · This guideline covers how to identify the adults, young people and children with non-alcoholic fatty liver disease (NAFLD) who have advanced liver fibrosis and are most at risk of further complications. Patient characteristics and clinical features should guide There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Normal: This means your liver has no scarring, or mild scarring. Jan 7, 2026 · A score less than 1. . Patient characteristics and clinical features should guide The table below, adopted from MSK, considers different scores in the context of different liver diseases and can be used to help determine fibrosis score. Google Scholar Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. 1,2 Although liver fibrosis is the strongest histologic predictor of liver-related outcome and all-cause mortality in Jun 13, 2020 · Histological Scoring System for Nonalcoholic Fatty Liver Disease Components of NAFLD Activity Score (NAS) and Fibrosis Staging Nonalcoholic Steatohepatitis Clinical Research Network There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in nonalcoholic fatty liver disease (NAFLD). 51 suggests advanced liver fibrosis and is an indication for referral to Hepatology clinic. Sep 25, 2025 · Nonalcoholic Fatty Liver Disease is the build-up of extra fat in liver cells not caused by alcohol. Repeat bloods/Repeat bloods/NAFLD score every 3-5 years. Keywords: NAFLD, liver fibrosis, liver biopsy, non-invasive assessment, liver stiffness Introduction Non-alcoholic fatty liver disease (NAFLD) refers to the presence of liver steatosis in the absence of factors that are known to induce lipid accumulation in hepatocytes, such as alcohol consumption or the use of steatogenic drugs. 5 Low risk for advanced liver fibrosis. FIB-4 1. We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of Using your liver stiffness result to find your fibrosis score Your healthcare provider will use your liver stiffness result and medical history to find out your fibrosis score. Mayo Clinic The Alcoholic Liver Disease/Nonalcoholic Fatty Liver Disease Index (ANI) calculator is a novel scoring system to distinguish alcoholic liver disease (ALD) from nonalcoholic fatty liver disease (NAFLD), for use by medical professionals. If the person is at high risk of advanced liver fibrosis, refer to a hepatology specialist for further assessment and management. Interpretive information The Table contains information useful in interpreting FIB-4 index values for NAFLD, hepatitis B, and hepatitis C. Recommend referral to Metabolic Hepatology Clinic. NAFLD affects 38% of adults worldwide. Additionally, we analyzed genomic data based on identical fibrosis grades and compared cases with identical NAS and fibrosis scores. FIB-4 >2. As per the locally agreed primary care pathway, the ELF test should be considered for the assessment of liver fibrosis in adult patients with NAFLD. It is important to be able to assess the severity of the disease process; in particular, it is essential to be able to assess the amount of fibrosis present, as this is the best predictor of The NAFLD fibrosis score is used to distinguish between patients with nonalcoholic fatty liver disease who have (F3-F4) and do not have (F0-F2) advanced fibrosis. The NAFLD Fibrosis Score is a validated, noninvasive tool for identifying patients whose MASLD has advanced to liver fibrosis. A sample report can be seen below: In clinical trials for NAFLD/NASH diagnosis, patients with a FIB-4 score <1. , FibroScan) and other blood-based tests, Dr. The NAFLD Fibrosis Score (NAFLD-FS) is the preferred non-invasive diagnostic option for detecting advanced fibrosis in NASH and is recommended by experts. Problems arise with the development of inflammation and fibrosis. Jul 6, 2016 · Overview This guideline covers how to identify the adults, young people and children with non-alcoholic fatty liver disease (NAFLD) who have advanced liver fibrosis and are most at risk of further complications. The 2022 AACE Guidelines provide the latest evidence-based recommendations for the diagnosis and management of Nonalcoholic Fatty Liver Disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Management of NAFLD in primary care includes: Feb 3, 2025 · Fatty liver on imaging Alcohol Use in NAFLD Chronic alcohol use can contribute to liver fat accumulation and fibrosis progression in patients with risk factors for NAFLD. Clinical Question Which patients with nonalcoholic fatty liver disease (NAFLD) have a low likelihood of fibrosis or cirrhosis? Nov 7, 2025 · The FIB-4 Index helps identify early signs of liver damage caused by conditions such as fatty liver disease (NAFLD), hepatitis, or alcohol-related liver injury.

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