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The preferred noninvasive initial test to assess the risk of NAFLD with liver fibrosis

Liver disease progression can lead to the development of fibrosis, cirrhosis, and other complications. According to recommendations for blood testing and referral developed by AACE and cosponsored by AASLD, the FIB-4 index is the preferred noninvasive initial test to assess the risk of NAFLD with liver fibrosis.1

The FIB-4 Index can assist you in determining which patients need:

  • Additional assessment of liver disease
  • Referral to a specialist

The easy-to-order, noninvasive Liver Fibrosis, Fibrosis-4 (FIB-4) Index from Quest Diagnostics yields a single score by combining:

  • Patient age (years)
  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT)
  • Platelet count (PLT)

FIB-4 Index interpretation information for patients with NAFLD2

Who is at risk of NAFLD with significant liver fibrosis and cirrhosis?1

The 2022 guidelines recommend adults with any of the following conditions are likely to have NAFLD and should be considered at high risk and assessed for liver fibrosis:

  • Obesity and/or features of metabolic syndrome
  • Prediabetes or type 2 diabetes
  • Hepatic steatosis on any imaging study and/or persistently elevated plasma aminotransferase levels (over 6 months)

Using the FIB-4 Index in clinical practice

AACE guideline recommendations include a cirrhosis prevention algorithm detailing how to use the FIB-4 Index in patients at risk for NAFLD and fibrosis.

See more details in the AACE recommendations for the diagnosis and management of NAFLD.

This information is provided for informational purposes only, and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.


*Note: For each panel, if FIB-4 Index is ≥1.30, then Enhanced Liver Fibrosis (ELF) Score (10350) will be performed at an additional charge (CPT code(s): 0014M).




  1. Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: cosponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-562. doi:10.1016/j.eprac.2022.03.010
  2. Kumar R, Teo EK, How CH, et al. A practical clinical approach to liver fibrosis. Singapore Med J. 2018;59(12):628-633. doi:10.11622/smedj.2018145


Please talk to your Quest account representative for ordering information on our NAFLD testing solutions

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