FIB-4

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Auckland Te Toka Tumai

Test Guide

FIB-4

Testing Laboratory

Auckland Te Toka Tumai | Auckland Hospital

Department

Chemical Pathology

Delphic Registration Code (Alpha Code)

FIB4

Test Code (Numeric Code)

4577

Laboratory Handling

Phlebotomy

Two different tubes are required to complete this test: The first tube should be EDTA AND the second tube should be Serum/ Plasma.

Sample Stability

Synonyms

Liver fibrosis score

Turnaround Time

3 hours

Specimen Type

Plasma
Serum
Whole Blood

Specimen Requirements

Tube/Container Type:

Preferred

EDTA (Lavender Cap)
Lithium Heparin PST- Gel (Light Green Cap)

Acceptable

EDTA (Lavender Cap)
Lithium Heparin - Non-gel (Green Cap)
Plain (Red Top)
SST II (Gold Cap)

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

EDTA (Microtainer)
Heparin (Microtainer)

Acceptable

EDTA (Microtainer)
Heparin (Microtainer)
SST(Microtainer)

Additional Specimen Information

4 mL EDTA Blood
Heparin 5 mL Heparin Blood
Plain 4 mL Plain Serum
SST 3.5 mL SST Blood
Micro-heparin 0.5 mL Micro-heparin Blood
Micro-EDTA 0.25mL
PST 4.5 mL PST Blood
Micro-PST 0.5 mL Micro-PST Blood

Diagnostic Use

FIB-4 is an evidence-based method to screen for significant liver fibrosis and risk of post-operative complications secondary to undetected significant liver disease. It is calculated as follows:

FIB-4 = [ (age in years) x ( AST in IU/L) ] / [ ( Platelet count per 10 9 /L) x v( ALT in IU/L) ]

Testing in MASLD

FIB-4 testing should be considered in patients at risk of metabolic dysfunction-associated steatotic liver disease (MASLD), this may be evidenced as:

Fatty liver reported on ultrasound, AND/OR
Otherwise unexplained raised ALT or AST on two samples, at least 3 months apart and not improving, AND any of the following:
i) Type 2 diabetes mellitus.

ii) Overweight or obese.

iii) Other cardiometabolic risk factors such as increased waist circumference, hypertension, hypertrygliceridaemia, low HDL, on lipid lowering therapy or pre-diabetes.

An increased FIB-4 may indicate further investigation, such as Fibroscan. Information on further management is available in the Auckland Region HealthPathway entry on ‘MASLD’ .

Testing in Preoperative Patients (specific to Te Toka Tumai)

FIB-4 can be used as a single preoperative screening tool for liver disease of any cause, including alcohol, MASLD or viral hepatitis. The consensus from the Te Toka Tumai liver team is that a single elevated FIB-4 score is sufficient to refer a preoperative patient to the NZ Liver Transplant Unit for consideration of a FibroScan, as the planned operation may not be safe to perform if significant liver disease is present.

Reference Intervals

Age less than 36 years	The FIB-4 score is unreliable in this age group. Consider an alternative fibrosis assessment method.
Age 36 – 59 years
Less than 1.3	Low probability of significant liver fibrosis.
Equal to or greater than 1.3	Significant liver fibrosis is not excluded by this result. Referral for Fibroscan may be indicated. If this is a preoperative patient, surgical/ anaesthetic risk may be increased.
Age greater than 59 years
Less than 2.0	Low probability of significant liver fibrosis.
Equal to or greater than 2.0	Significant liver fibrosis is not excluded by this result. Referral for Fibroscan may be indicated. If this is a preoperative patient, surgical/ anaesthetic risk may be increased.

Test Method

FIB-4 is not measured directly, and is instead a score based on three different test results + age:

ALT
http://testguide.adhb.govt.nz/EGuide/?elv=1&name=ALT&pn=2281&mn=1092&sd=3&ts=19b32f63bf5
AST
http://testguide.adhb.govt.nz/EGuide/?elv=1&name=AST&pn=685&mn=427&sd=3&ts=19b32f5ea5a
Platelet count
http://testguide.adhb.govt.nz/EGuide/?elv=1&name=Full%20Blood%20Count&pn=305&mn=213&sd=3&ts=19b32f59cb7

Last updated: 26/03/2026

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FIB-4

Overview

Testing Laboratory

Department

Delphic Registration Code (Alpha Code)

Test Code (Numeric Code)

Laboratory Handling

Phlebotomy

Sample Stability

Synonyms

Turnaround Time

Specimen

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Additional Specimen Information

Referral

Additional Referral/Aliquot Information

Clinical Information/Test Method

Diagnostic Use

Reference Intervals

Test Method

Additional Information

Contact Information

Contact Information

Enquiry Form

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