LiverRisk Score Outperforms FIB-4 for Detecting Significant Liver Fibrosis, suggests study

A new research published in the journal of Digestive and Liver Disease revealed that in the general US population, the LiverRisk score (LRS) demonstrated greater accuracy than the FIB-4 index for identifying moderate or greater liver fibrosis. In the study, based on liver stiffness measurements of ≥8 and ≥10 kPa. FIB-4 performed particularly poorly in adults younger than 65 years, with many individuals who had elevated liver stiffness still showing FIB-4 values below the conventional 1.30 cutoff. These findings suggest that LRS may improve the detection of clinically significant fibrosis, especially in younger adults.

Liver fibrosis often develops silently before advancing to more severe liver disease. Early identification is critical to enabling timely intervention and reducing the risk of complications. While the Fibrosis-4 (FIB-4) index has long served as a primary non-invasive test (NIT) for fibrosis risk assessment, previous evidence has indicated that its performance may be limited in populations where advanced fibrosis is less common and among younger individuals.

To evaluate whether a newer assessment tool could improve detection, this study compared the LiverRisk Score (LRS) with FIB-4 using data from 12,050 participants enrolled in NHANES between 2017 and 2023. The study assessed the ability of both scores to classify liver stiffness measurements (LSM) of at least 8 kilopascals (kPa) and 10 kPa, thresholds commonly associated with clinically significant and advanced liver fibrosis.

The analysis found that the LiverRisk Score consistently outperformed FIB-4 across all age groups. For participants with liver stiffness of 8 kPa or higher, the LRS achieved an area under the curve (AUC) ranging from 0.662 in adults aged 18–34 years to 0.711 in those aged 35–64 years. In comparison, the FIB-4 index recorded considerably lower AUC values, ranging from 0.510 to 0.591 in the same age groups. Similar improvements were observed when evaluating participants with liver stiffness of at least 10 kPa, reinforcing the superior predictive performance of the newer scoring system.

The findings indicated that the LiverRisk Score maintained better diagnostic accuracy than FIB-4, suggesting its potential utility in broader population screening where metabolic disorders such as obesity and diabetes are increasingly prevalent. Overall, the LiverRisk Score demonstrated greater accuracy than the traditional FIB-4 index for identifying individuals with clinically relevant liver stiffness at both the 8 kPa and 10 kPa thresholds. 

Source:

Rinella, M. E., Charlton, M. R., Kim, Y., Hosmane, S., Woolley, J. J., & O’Connell, T. (2026). Accuracy of the FIB-4 and LiverRisk score for use in primary risk assessment for liver fibrosis, and variation by age. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 58(7), 935–942. https://doi.org/10.1016/j.dld.2026.04.011