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

A new study published in the journal of Digestive and Liver Diseases showed that when it came to diagnosing moderate or higher liver fibrosis in the overall US population, the LiverRisk score (LRS) outperformed the FIB-4 index.

While its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), can result in fibrosis, cirrhosis, hepatocellular carcinoma, cardiovascular events, and increased mortality, metabolic dysfunction-associated steatotic liver disease (MASLD) is very common yet frequently asymptomatic.

Although liver biopsy is still the gold standard for assessing fibrosis, its invasiveness has led to the widespread use of non-invasive tests (NITs), such as imaging methods like vibration-controlled transient elastography (VCTE) and blood-based markers like the Fibrosis-4 (FIB-4) index. For initial fibrosis screening, FIB-4 is recommended by current international guidelines; however, its cutoffs were developed from patients with established liver disease and may perform inconsistently across various age groups, sexes, and primary-care populations with metabolic risk factors but no confirmed liver disease.

In population-based research, the LiverRisk Score, which was created utilizing standard clinical and biochemical factors, has proven to be more accurate than FIB-4 in predicting high liver stiffness. This study examines the diagnostic performance of FIB-4 and LRS across age groups and metabolic risk profiles using the extended NHANES 2021–2023 dataset.

The National Health and Nutrition Examination Survey (NHANES) cycles from 2017 to 2023 were analyzed. Area-under-the-curve (AUC) was used to assess the accuracy of the LRS vs. FIB-4 for the categorization of LSM ≥8 kPa and ≥10 kPa across three age groups and metabolic risk variables.

There were N = 12,050 participants in the research.

AUC (95% confidence interval) for the LRS varied from 0.662 (0.614–0.710) at ages 18–34 to 0.711 (0.689–0.731) at ages 35–64, and for FIB-4 from 0.510 (0.462–0.559) to 0.591 (0.567–0.614) (n = 1310).

Additionally, across the age ranges evaluated, the LRS showed better accuracy compared to FIB-4 for LSM ≥10 kPa (n = 724).

Overall, when it came to identifying persons with moderate or higher fibrosis who would benefit from innovative therapies, the LRS outperformed the FIB-4 in this research. All age groups showed the better accuracy of the LRS, although it was most noticeable at younger ages, when the FIB-4's accuracy is known to be deficient.

Reference:

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