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Free fibrosis-risk tool

FIB-4 Calculator: Check Your Fatty Liver Fibrosis Risk

FIB-4 estimates your risk of advanced liver scarring from four routine numbers: age, AST, ALT and platelet count. Below 1.3 (below 2.0 over age 65) is low risk; 1.3 to 2.67 is a grey zone where a FibroScan helps; above 2.67 is higher risk. Enter your values below to see your score in a minute.

Reviewed by Dr. Rejeesh Menon, MBBS, MD, FACP, Internal Medicine (TCMC Reg. 40073). Last reviewed 24 October 2026.

The short two or three digit figure such as 250 (the x10⁹/L value). An Indian report showing 2,50,000 or 2.5 lakh is the same as 250, so do not type the long number.
Tick any that apply (these change the advice, not the score):

Nothing you type here is saved or sent. The score is worked out in your own browser.

What FIB-4 measures, and what the number means

FIB-4 does not look at your liver directly. It is a formula that combines your age, the two liver enzymes AST and ALT, and your platelet count into a single number that tracks the chance of advanced scarring (fibrosis). The reason it works is that as a liver scars, these routine values drift in a predictable way. It is the test that major guidelines recommend first, before any scan, because it is cheap, validated, and uses numbers you may already have (EASL-EASD-EASO 2024).

The formula is straightforward, and you can check it by hand: FIB-4 = (age in years x AST) divided by (platelet count x the square root of ALT), where the platelet count is the x10^9/L figure (250, not 2,50,000). As a liver scars it tends to push AST up and platelets down, so the number climbs.

FIB-4 interpretation bands and the action each one triggers
FIB-4 scoreWhat it suggestsWhat to do next
Below 1.3 (below 2.0 over age 65)Low risk of advanced fibrosisAdvanced scarring is unlikely. Treat the metabolic drivers and recheck in one to three years.
1.3 to 2.67Indeterminate (grey zone)A FibroScan (transient elastography) is the sensible next step.
Above 2.67Higher risk of advanced fibrosisA FibroScan and a physician or liver-specialist review are warranted.
One honest limit. FIB-4 can read falsely low in people with type 2 diabetes or obesity; in one large dataset a FIB-4-first pathway missed roughly 60 percent of those who actually had meaningful liver stiffness. If you have diabetes, a FibroScan is worth doing even with a low score, which is why this tool flags it for you. FIB-4 is also least reliable at the extremes of age: the same analysis flagged none of the under-35s who had raised liver stiffness, and it over-calls fibrosis over 65, which is why the low cut-off rises to 2.0. It works best between roughly 35 and 65, and a FibroScan settles the question at any age.

Questions worth asking your doctor

  • Given my FIB-4 and my risk factors, do I need a FibroScan now?
  • Should my diabetes or blood pressure treatment change to protect my liver?
  • What weight and waist target would most help my liver, and over what time?
  • How often should my FIB-4 and liver enzymes be rechecked?

What your AST, ALT and platelet numbers should look like

You do not need normal values to run FIB-4 (the fibrosis-4 index); you enter whatever your report shows. For reference, most labs call an ALT or AST up to about 40 U/L normal, though the genuinely healthy range is lower, roughly 29 to 33 U/L for men and 19 to 25 U/L for women. A platelet count usually sits around 150 to 410 x10^9/L, which is the two or three digit figure on your report, not the long 2,50,000 version. The SGPT and SGOT guide explains what a raised enzyme means on its own.

FIB-4 compared with the other fibrosis tests

FIB-4 is a screening score for fatty liver (NAFLD, now called MASLD). It is not the only way to estimate scarring, but it is the one guidelines reach for first, because it is free and uses blood you already have.

How FIB-4 compares with other fibrosis tests
TestWhat it isWhere it fits
FIB-4A score from age, AST, ALT and plateletsFirst-line triage, free, decides who needs more testing
FibroScanA probe that measures liver stiffness (kPa) and fat (CAP)The next step when FIB-4 is not low
APRIAn older blood score from AST and plateletsStill seen, but FIB-4 performs better in fatty liver
Liver biopsyA needle sample of liver tissueThe reference standard, now rarely needed for fatty liver

A low FIB-4 is reassuring; a grey-zone or high score is a prompt for a FibroScan, which puts a direct number on scarring.

FibroScan cost and where to get one

A FibroScan is the usual next test when FIB-4 is not low. In India it generally costs about 2,000 to 5,000 rupees at a diagnostic centre or hospital, a one-time fee rather than a recurring cost. How to read the CAP and kPa numbers it gives, and the cost in more detail, are on the FibroScan explainer.

FIB-4 questions

Common questions about your FIB-4 score

FIB-4 is a simple score that estimates the chance of advanced liver scarring (fibrosis) without a biopsy. It is calculated from four numbers on an ordinary blood report: your age, two liver enzymes called AST and ALT, and your platelet count. It is recommended as the first-line fibrosis check in major guidelines (EASL-EASD-EASO 2024).
Below 1.3 is considered low risk for advanced fibrosis if you are 65 or younger. Over the age of 65 the low cut-off rises to 2.0, because the score naturally climbs with age. A score between 1.3 and 2.67 is a grey zone, and above 2.67 is higher risk. A low score is reassuring, but it is a risk estimate, not a guarantee.
Both are genuine FIB-4 cut-offs, derived in different patients. The original 1.45 and 3.25 come from a 2006 study in people with HIV and hepatitis C co-infection (Sterling 2006). For fatty liver (NAFLD/MASLD) the validated thresholds are lower, 1.3 and 2.67, and that is what current guidelines recommend (EASL-EASD-EASO 2024), with the low cut-off rising to 2.0 over age 65. This tool uses the fatty-liver thresholds because that is the population it is built for.
They are on a routine blood report. AST is sometimes printed as SGOT and ALT as SGPT, both in units per litre (U/L). The platelet count is part of a complete blood count (CBC). Enter it as the short two or three digit figure such as 250 (the x10^9/L value); an Indian report showing 2,50,000 or 2.5 lakh is the same number as 250, so do not type the long version. If you have had these tests in the last few months, you usually do not need a fresh blood draw.
Yes. FIB-4 can read falsely low in people with type 2 diabetes or obesity. In one large dataset a FIB-4-first pathway missed roughly 60 percent of people who actually had meaningful liver stiffness. If you have diabetes, a FibroScan is worth doing even when your FIB-4 looks reassuring, which is why this tool flags it.
Often no, if you have no diabetes or obesity and no warning signs; the plan is then to treat the metabolic drivers and recheck in one to three years. If your score is in the grey zone or high, or you have diabetes, a FibroScan is the next step. Kerala has also begun opening fatty liver screening clinics in government hospitals, starting with Tirur District Hospital in Malappuram, for assessment and early care.
No. A high score means a higher chance of advanced fibrosis and a reason to look closer with a FibroScan and a specialist, not a diagnosis of cirrhosis. Many people with a raised FIB-4 do not have cirrhosis. The score points you to the right next test; it does not replace it.
No. The calculation happens entirely in your own browser. Nothing you enter is stored, and no name, phone number or health value is sent anywhere. You can use the tool as many times as you like without sharing any personal information.
Not quite. A low FIB-4 means advanced scarring is unlikely, which is genuinely reassuring, but the fatty liver and its drivers (weight, blood sugar, lipids) still need managing. Losing around 7 to 10 percent of body weight improves the liver in most people. A low score is a reason to act early, while it is easiest, not a reason to ignore it.
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Sources

References

  1. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection (the original FIB-4 index). Hepatology. 2006;43(6):1317-1325. View on PubMed
  2. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542 (non-invasive FIB-4 then elastography algorithm; age-over-65 cut-off of 2.0). View on DOI
  3. FIB-4-based referral pathways have suboptimal accuracy to identify increased liver stiffness and incident advanced liver disease. Clinical Gastroenterology and Hepatology. 2025 (a FIB-4-first pathway missed meaningful liver stiffness in many patients, with 0 percent sensitivity in the 18 to 35 age group). View on PubMed

FIB-4 is a screening estimate, not a diagnosis. Your doctor reads it alongside your scans, your history and your other results.