The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B

Aliment Pharmacol Ther. 2009 Feb 15;29(4):409-15. doi: 10.1111/j.1365-2036.2008.03895.x. Epub 2008 Nov 17.


Background: The Fib-4 index is a simple and inexpensive biomarker to delineate liver fibrosis in chronic hepatitis C.

Aim: To assess the accuracy of the FIB-4 index in chronic hepatitis B.

Methods: We compared the FIB-4 index with 138 synchronous liver biopsies and with 372 synchronous FibroTest performed either in France or in an endemic area (Mayotte, an overseas collectivity of France).

Results: The FIB-4 index allowed the correct identification of patients with nil-to-moderate fibrosis with an area under the receiving operating characteristic curve of 0.81 (P < 0.001), increasing as a function of the length of the liver biopsy (up to 0.94 for liver biopsies >or=20 mm). A cut-off value <or=1.45 differentiated moderate fibrosis from severe fibrosis with a negative predictive value of 86%, a sensitivity of 71.1% and a specificity of 73.1%. Beyond 1.45, the FIB-4 index was not informative. The FIB-4 index was more precise than the AST-to-platelet ratio index and correlated with the FibroTest in 89% of the cases (kappa = 0.27, P < 0.001) to exclude severe fibrosis.

Conclusion: The FIB-4 index is a simple, accurate and inexpensive method to exclude significant liver fibrosis in chronic hepatitis B, a major advantage in HBV-endemic developing countries.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alanine Transaminase*
  • Aspartate Aminotransferases*
  • Biomarkers
  • Comoros
  • Female
  • France
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / diagnosis*
  • Hepatitis B, Chronic / pathology
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / pathology
  • Liver Function Tests
  • Male
  • Middle Aged
  • RNA, Viral / blood
  • ROC Curve


  • Biomarkers
  • RNA, Viral
  • Aspartate Aminotransferases
  • Alanine Transaminase