ArticleHepatology communications2019
Impact of Implementing a "FIB-4 First" Strategy on a Pathway for Patients With NAFLD Referred From Primary Care.
Article in Hepatology communications, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
61 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Diffusion-weighted magnetic resonance imaging for the assessment of liver fibrosis in chronic viral hepatitis.PloS one · 2021Trial
- Upcoming therapies for steatotic liver disease: Translating breakthroughs into clinical practice.Journal of internal medicine · 2026Review
- Steatotic Liver Disease Risk Scores to Predict Cirrhosis and Hepatocellular Carcinoma.JAMA internal medicine · 2026Article
- Cost-Effectiveness of AI-Enabled Electrocardiography for Screening MASLD-Associated Advanced Chronic Liver Disease in the US Population.Digestive diseases and sciences · 2026Article
- Metabolic dysfunction-associated steatotic liver disease assessment and management: Clinical practice guidance from the Canadian Association for the Study of the Liver.Canadian liver journal · 2026Article
- Diagnostic performance of FIB-4 in detecting advanced liver fibrosis in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis using methotrexate.Advances in rheumatology (London, England) · 2026Observational
- Article
- Hepatocellular carcinoma with extensive fatty change: a case description.Quantitative imaging in medicine and surgery · 2026Article
- Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways.JHEP reports : innovation in hepatology · 2026Article
- Sequential Fibrosis-4 Index and Mac-2 Binding Protein Glycosylation Isomer Combination Improve Detection of Advanced Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Multicenter Study.Gastro hep advances · 2026Article
- Risk stratification of metabolic dysfunction-associated steatotic liver disease: The KASL pathway: Editorial on "Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease".Clinical and molecular hepatology · 2026Article
- Proactive case-finding and risk-stratification in people at risk of chronic liver disease in Greater Manchester: a cost-effectiveness analysis.BMJ public health · 2026Article
- Liver Fibrosis as a Predictor of Cardiovascular Risk in Patients with Severe Obesity.Journal of clinical medicine · 2025Article
- Implementation of noninvasive liver disease screening tools in primary care.Korean journal of family medicine · 2025Article
- Simple Clinical Prediction Rules for Identifying Significant Liver Fibrosis: Evaluation of Established Scores and Development of the Aspartate Aminotransferase-Thrombocytopenia-Albumin (ATA) Score.Diagnostics (Basel, Switzerland) · 2025Article
- Approach to steatotic liver disease in the office: Diagnosis, management, and proposed nomenclature.Canadian family physician Medecin de famille canadien · 2025Review
- Observational
- Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach.BMC health services research · 2025Article
- Patterns of gastroenterology specialty referral for primary care patients with metabolic dysfunction-associated steatotic liver disease.The American journal of the medical sciences · 2024Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is essential for stratifying patients according to the risk of liver-related morbidity. Noninvasive methods such as vibration-controlled transient elastography (VCTE) and Fibrosis-4 index (FIB-4) have been recommended to identify patients for further assessment. The aim of this study was to assess the potential impact of implementing a "FIB-4 First" strategy to triage patients entering a NAFLD assessment pathway. The pathway for patients with suspected NAFLD was piloted at a tertiary liver center. Referral criteria were 16-65 years old, elevated alanine aminotransferase and/or steatosis on imaging, and absence of a previous liver diagnosis. A registered nurse risk-stratified all patients based on VCTE and FIB-4 was calculated. Potential alternative diagnoses were excluded with bloodwork. A total of 565 patients underwent risk stratification with VCTE with a 97% success rate. Ten percent had VCTE of at least 8 kPa; 560 patients had FIB-4 available for analysis and 87% had values less than 1.3. Of those with a FIB-4 of at least 1.3, 69% had a VCTE less than 8 kPa. Further modeling showed that the presence of diabetes, age, and body mass index had only a moderate impact on the association between FIB-4 and elastography values if using a FIB-4 threshold of 1.3.
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