Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds

Kimura, Shohei; Tamaki, Nobuharu; Higuchi, Mayu; Shima, Takuya; Taguchi, Mina; Yamazaki, Yudai; Seike, Risa; Uchihara, Naoki; Tanaka, Yuki; Kobayashi, Ryohei; Yagita, Junko; Kasano, Yuka; Komiyama, Yasuyuki; Takaura, Kenta; Takada, Hitomi; Tanaka, Shohei; Maeyashiki, Chiaki; Yasui, Yutaka; Nakanishi, Hiroyuki; Tsuchiya, Kaoru; Izumi, Namiki; Kurosaki, Masayuki

doi:10.3390/jcm14238473

This is an early access version, the complete PDF, HTML, and XML versions will be available soon.

Open AccessArticle

Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds

by

Shohei Kimura

^†

,

Nobuharu Tamaki

^†,

Mayu Higuchi

,

Takuya Shima

,

Mina Taguchi

,

Yudai Yamazaki

,

Risa Seike

,

Naoki Uchihara

,

Yuki Tanaka

,

Ryohei Kobayashi

,

Junko Yagita

,

Yuka Kasano

,

Yasuyuki Komiyama

,

Kenta Takaura

,

Hitomi Takada

,

Shohei Tanaka

,

Chiaki Maeyashiki

,

Yutaka Yasui

,

Hiroyuki Nakanishi

,

Kaoru Tsuchiya

,

Namiki Izumi

and

Masayuki Kurosaki

^* Show full author list Hide full author list

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 180-8610, Japan

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2025, 14(23), 8473; https://doi.org/10.3390/jcm14238473 (registering DOI)

Submission received: 7 October 2025 / Revised: 19 November 2025 / Accepted: 27 November 2025 / Published: 28 November 2025

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

Download Versions Notes

Abstract

Background and Aims: Given the high prevalence of chronic liver diseases, non-invasive assessment of liver fibrosis is critical for screening and management of these conditions. While the FIB-4 index is widely used, its age-dependent nature may reduce specificity in older adults. The FIB-3 index, which excludes age, has been proposed as an alternative. This study aimed to compare the diagnostic performance of FIB-3 and FIB-4 for detecting advanced fibrosis across age groups using magnetic resonance elastography (MRE) as the reference standard. Methods: We retrospectively analyzed 3424 patients aged ≥30 years with chronic liver disease who underwent MRE. Advanced fibrosis was defined as liver stiffness ≥ 3.62 kPa. The cutoff values and diagnostic performance of the FIB-4 and FIB-3 indices for advanced fibrosis were evaluated within subgroups stratified by age quartiles (Q1–Q4), and the areas under the ROC curves (AUROCs) were compared using DeLong’s test. Results: Both FIB-3 and FIB-4 indices demonstrated comparable diagnostic accuracy for advanced fibrosis (AUROC 0.82 (95% CI: 0.81–0.83) for both; p = 0.70). In age-stratified analysis, the cutoff values for the FIB-4 index increased with increasing age (Q1: 1.72, Q2: 2.90, Q3: 3.66, Q4: 4.20), reflecting its age-dependent formula. In contrast, the FIB-3 index exhibited relatively minor variation in cutoff values across quartiles (Q1: 2.32, Q2: 3.52, Q3: 3.74, Q4: 3.14). Conclusions: FIB-3 index offers similar diagnostic accuracy to FIB-4 index while demonstrating more consistent performance across age groups. These findings provide evidence that FIB-3 index may be a useful alternative, particularly in older populations where FIB-4 index interpretation may be confounded by age.

Keywords: non-invasive assessment of liver fibrosis; MR elastography; FIB-4 index; FIB-3 index

Share and Cite

MDPI and ACS Style

Kimura, S.; Tamaki, N.; Higuchi, M.; Shima, T.; Taguchi, M.; Yamazaki, Y.; Seike, R.; Uchihara, N.; Tanaka, Y.; Kobayashi, R.; et al. Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds. J. Clin. Med. 2025, 14, 8473. https://doi.org/10.3390/jcm14238473

AMA Style

Kimura S, Tamaki N, Higuchi M, Shima T, Taguchi M, Yamazaki Y, Seike R, Uchihara N, Tanaka Y, Kobayashi R, et al. Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds. Journal of Clinical Medicine. 2025; 14(23):8473. https://doi.org/10.3390/jcm14238473

Chicago/Turabian Style

Kimura, Shohei, Nobuharu Tamaki, Mayu Higuchi, Takuya Shima, Mina Taguchi, Yudai Yamazaki, Risa Seike, Naoki Uchihara, Yuki Tanaka, Ryohei Kobayashi, and et al. 2025. "Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds" Journal of Clinical Medicine 14, no. 23: 8473. https://doi.org/10.3390/jcm14238473

APA Style

Kimura, S., Tamaki, N., Higuchi, M., Shima, T., Taguchi, M., Yamazaki, Y., Seike, R., Uchihara, N., Tanaka, Y., Kobayashi, R., Yagita, J., Kasano, Y., Komiyama, Y., Takaura, K., Takada, H., Tanaka, S., Maeyashiki, C., Yasui, Y., Nakanishi, H., ... Kurosaki, M. (2025). Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds. Journal of Clinical Medicine, 14(23), 8473. https://doi.org/10.3390/jcm14238473

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Menu

Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds

Abstract

Share and Cite

Article Metrics

Article Access Statistics

Further Information

Guidelines

MDPI Initiatives

Follow MDPI