Fibrosis-4 (FIB-4) Calculator
Interpretation:
Sources
This calculator operates entirely from your device.
No input variables or data is transmitted between your computer and our servers.
When a patient enters care for management of HCV, it is important to confirm the individual has chronic HCV infection (e.g., they are viremic based on a positive HCV RNA) as opposed to resolved HCV (positive HCV antibody with a negative or undetectable HCV RNA). During the initial evaluation, it is similarly important to obtain a thorough history and perform a careful physical examination, focusing on risk factors for HCV acquisition, current or past substance use disorders, significant medical comorbidities, current medications, and manifestations of chronic liver disease. Determining cirrhosis status is a high priority before treatment is started, and it can be done with readily available non-invasive laboratory markers.
A core set of laboratory tests are indicated for persons prior to treatment for HCV.[1] The major goals of the initial laboratory evaluation are to: (1) confirm chronic HCV infection using either laboratory-based or point-of-care HCV RNA testing; (2) evaluate liver injury and function; (3) obtain markers for Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) or FIB-4 calculation; and (4) evaluate for co-occurring viral infections. The following summarizes the major tests that should be obtained prior to or at the time of treatment initiation.[2,3,4] The subsequent section addresses recommended laboratory tests and the timing of ordering these tests based on the cirrhosis status of the adult with chronic HCV.
As outlined below, for the simplified treatment approach, the following summarizes the AASLD/IDSA hepatitis C guidance for pretreatment laboratory testing recommendations in adults with chronic HCV without cirrhosis (Figure 1).[8]
As outlined below, for the simplified treatment approach, the following summarizes the AASLD/IDSA hepatitis C guidance for pretreatment laboratory testing recommendations in adults with chronic HCV with compensated cirrhosis (Figure 2).[4]
Hepatic fibrosis is a dynamic scarring process that occurs over time in patients with chronic HCV and can lead to cirrhosis.[9,10] It is important to evaluate for liver fibrosis and cirrhosis in patients with chronic HCV for multiple reasons:
Historically, hepatic fibrosis was assessed via liver biopsy; however, liver biopsy is no longer required for cirrhosis assessment. Instead, there are now several noninvasive methods to estimate hepatic fibrosis that are recommended and commonly used in clinical practice. These include laboratory-based calculations (e.g., APRI, FIB-4, FibroSure) and elastography (e.g., FibroScan).
You must answer all of the questions before checking your work.
For the purpose of the AASLD/IDSA simplified treatment algorithm, a patient is presumed to have cirrhosis if they have any of the following:[4]
The choice of noninvasive testing to stage fibrosis in patients with HCV will often depend on the resources available to each clinic. The AASLD/IDSA simplified algorithm for the treatment of HCV recommends calculating a FIB-4 score in all patients for fibrosis staging.[4] The FIB-4 score, as noted above, can be calculated using three routine laboratory values (platelet count, AST, and ALT) and may be sufficient in most cases.[4,8] If available, some experts also recommend obtaining a FibroScan, since this test represents one of the more accurate noninvasive methods for evaluating hepatic fibrosis in patients with HCV. The major limitation to FibroScan is cost and lack of access to this test in many health care settings. In primary care settings and other settings where FibroScan is often used when non-invasive markers of fibrosis are discordant or there are other aspects of the patient’s history and/or examination that introduce uncertainty regarding fibrosis stage.
You may find more information and a scenario for which you can use this calculator in the following activity from our curriculum:
This calculator operates entirely from your device.
No input variables or data is transmitted between your computer and our servers.
You must answer all of the questions before checking your work.
For all patients with presumed or documented cirrhosis, it is important to identify those individuals who have decompensated cirrhosis (moderate or severe hepatic impairment). Decompensated cirrhosis is defined by the presence of a Child-Turcotte-Pugh (CTP) score of ≥7 (class B = 7-9 or Class C = 10-15). A CTP score can be determined easily with a CTP calculator, which requires assessment of two clinical findings (encephalopathy and ascites) in combination with three laboratory values (serum bilirubin, serum albumin, and INR).[22] All individuals with a CTP score of ≥7 (class B or C) should be considered to have decompensated cirrhosis and promptly referred to a hepatologist (or other comparable expert) experienced in managing persons with decompensated cirrhosis.[23] The simplified treatment approach should not be used in persons with decompensated cirrhosis.
You may find more information and a scenario for which you can use this calculator in the following activities from our curriculum:
This calculator operates entirely from your device.
No input variables or data is transmitted between your computer and our servers.
You must answer all of the questions before checking your work.
Since you've received 80% or better on this quiz, you may claim continuing education credit.
You seem to have a popup blocker enabled. If you want to skip this dialog please Always allow popup windows for the online course.
Account Registration Benefits:
Create a free account to get started