Hepatology
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See the full rubric →Assessing Strategies to Mitigate the Effect of Age When Using FIB-4 Index to Screen for MASLD-Related Liver Fibrosis.
Clinical takeawayIn MASLD patients at age extremes (<35 or ≥65 years), use FIB-3 (AST/ALT/platelet-based, age-omitted) instead of standard FIB-4 for fibrosis screening. It maintains equivalent diagnostic accuracy without the age-related bias that causes FIB-4 to underestimate risk in younger patients and overestimate in older patients, pending prospective confirmation for guideline adoption.
What it foundFIB-3 (age-removed from FIB-4; exact formula in source paper) maintained diagnostic accuracy of standard FIB-4 for detection of ≥F2 and ≥F3 MASLD fibrosis (AUROCs 0.76-0.78 vs MRE, 0.77-0.81 vs biopsy, all five strategies similar), while demonstrating improved sensitivity-specificity balance specifically at age extremes (<35 and ≥65 years).
ContextFIB-4 is guideline-recommended for MASLD screening but has known limitations at age extremes: the formula overestimates fibrosis in older patients and underestimates it in younger patients because age is a direct component. This study validates that removing age (FIB-3) maintains equivalent diagnostic accuracy while eliminating this bias, suggesting age-independent calculation could improve screening across age strata.
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Nammi J … Bril F · Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association · IF 16.2 · PubMed ↗