In r/medicine, clinicians compare how to use FIB-4 cutoffs to keep low-risk fatty liver patients in primary care while routing higher-risk cases to elastography and hepatology, noting age-adjusted thresholds and test limitations.
Derm: FIB-4 is in our guidelines for risk stratification and monitoring for chronic methotrexate toxicity before sending for elastography
PCPs out there, you should really only be sending patients to GI/Hepatology for MASLD/MASH (probably MASH if they have these numbers) whose FIB4 is >1.3 (or >2.0 over age 65 when the cutoff rises).
Elastography isn't all the same. US with elastography is going to give you an estimate of fibrosis (and this is most widely available) but unfortunately it doesn't give a fat fraction.
Anyone here use FIB-4? Just ran across this and I don't mind admitting it was new to me.
<1.3 low risk manage in primary care (lifestyle, metabolic control)
FIB-4 is in our guidelines for risk stratification and monitoring for chronic methotrexate toxicity before sending for elastography
FIB-4=Age×AST/platelets×(ALT^0.5)
1.32.67 indeterminate then consider elasto
Use it like this:
Elastography isn't all the same.
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