Diagnostic Accuracy of FIB-4 Score Compared with FibroScan (Transient Elastography as Gold Standard) in the Assessment of Liver Fibrosis in Patients with Chronic Liver Disease

Abstract

Background: Early identification of liver fibrosis is essential for prognosis and treatment of chronic liver disease (CLD), a significant worldwide health issue. Although liver biopsy is considered the gold standard, its application is limited, and non-invasive markers such as the Fibrosis-4 (FIB-4) score and FibroScan are becoming more and more popular.

Objective: To determine the diagnostic accuracy of the FIB-4 score compared with FibroScan (transient elastography as the gold standard) in assessing liver fibrosis in patients with chronic liver disease.

Methods: A cross-sectional research of diagnostic accuracy was carried out at Shalamar Medical and Dental College/Shalamar Hospital in Lahore between October 1, 2025, and March 31, 2026. A total of 118 patients with chronic liver disease were chosen using the consecutive sampling approach. Age, AST, ALT, and platelets were used to calculate FIB-4 scores, and FibroScan was used to quantify liver stiffness. ROC curve analysis, kappa statistics, sensitivity, specificity, and predictive values were used to evaluate the diagnostic performance.

Results: The FIB-4 score demonstrated good diagnostic abilities for severe fibrosis, with a sensitivity of 88.2%, specificity of 81.5%, accuracy of 85.6%, and AUC of 0.89. The AUC was 0.91 with excellent diagnostic agreement with FibroScan (κ = 0.70) for advanced fibrosis. A large percentage of patients were noted to have significant fibrosis or cirrhosis by FibroScan.

Conclusions: The FIB-4 is a simple, inexpensive, and frequently used non-invasive marker for liver fibrosis in CLD patients. It is compatible with FibroScan and may be used as a first-line screen, especially in resource-limited areas.