Activity 3C. Calculating FIB-4 Score PDF Share Learning Objective Performance Indicators Initiate a comprehensive clinical and laboratory evaluation prior to treating a person for HCV infection Obtain the recommended core set of laboratory tests indicated for persons prior to starting HCV treatment Differentiate laboratory testing recommendations in persons with HCV based on cirrhosis status Correctly interpret test results for noninvasive assessment tools used to stage liver fibrosis Recognize the conditions that would lead to a presumptive diagnosis of decompensated cirrhosis Instructions Read the case history, use the FIB-4 calculator below to calculate the FIB-4 score, and then answer the Activity Question.Case HistoryA 54-year-old man presents for hepatitis C virus (HCV) care. He was diagnosed with chronic HCV over twenty years ago, shortly after a period of injection drug use. On physical examination, he has a firm liver edge and palpable spleen tip. He has never been treated before. Baseline laboratory studies show a platelet count of 92 x 109/L, alanine aminotransferase (ALT) = 56 U/L, aspartate aminotransferase (AST) = 75 U/L.Fibrosis-4 (FIB-4) Calculator ShareThe Fibrosis-4 score helps to estimate the amount of scarring in the liver. Enter the required values to calculate the FIB-4 value. It will appear in the oval on the far right (highlighted in yellow). FIB-4 = Age (years) x AST Level (U/L) Platelet Count (109/L) x √ ALT (U/L) = Interpretation: Using a lower cutoff value of 1.45, a FIB-4 score <1.45 had a negative predictive value of 90% for advanced fibrosis (Ishak fibrosis score 4-6 which includes early bridging fibrosis to cirrhosis). In contrast, a FIB-4 >3.25 would have a 97% specificity and a positive predictive value of 65% for advanced fibrosis. In the patient cohort in which this formula was first validated, at least 70% patients had values <1.45 or >3.25. Authors argued that these individuals could potentially have avoided liver biopsy with an overall accuracy of 86%. Sources Sterling RK, Lissen E, Clumeck N, et. al. Development of a simple noninvasive index to predict significant fibrosis patients with HIV/HCV co-infection. Hepatology 2006;43:1317-1325. Related ActivitiesYou may find more information and a scenario for which you can use this calculator in the following activity from our curriculum:Calculating FIB-4 Score This calculator operates entirely from your device. No input variables or data is transmitted between your computer and our servers. Share by e-mail From:Enter your e-mail address To: Enter the e-mail address of the recipient Your Message: View all Clinical Calculators Activity QuestionYou should answer this question after completing the activity. You must answer all of the questions before checking your work. What is this patient’s FIB-4 score and how would you interpret this result. 1.30 and unlikely to have cirrhosis 2.60 and unlikely to have cirrhosis 5.88 and high probability of having cirrhosis Share by e-mail From:Enter your e-mail address To: Enter the e-mail address of the recipient Your Message: Check-On-LearningQuestionsThe Check-on-Learning Questions are short and topic related. They are meant to help you stay on track throughout each lesson and check your understanding of key concepts.You must be signed in to customize your interaction with these questions.
