ArticleBMC gastroenterology2026
Diagnostic performance of FIB-6 for identifying FibroScan-defined advanced fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): a cross-sectional diagnostic accuracy study.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease worldwide. Accurate non-invasive identification of advanced fibrosis is essential for risk stratification and management. The Fibrosis-6 (FIB-6) score is a recently developed serum-based index, but its performance in MASLD remains unclear.
methodsIn this retrospective cross-sectional study, 397 adults with MASLD who underwent FibroScan were included. FibroScan-derived liver stiffness categories were used as the surrogate comparator for fibrosis assessment. The diagnostic performance of FIB-6 was evaluated using ROC analysis for significant fibrosis (F2-F4), advanced fibrosis (F3-F4), and cirrhosis (F4), and compared with FIB-4, APRI, NAFLD fibrosis score (NFS), and AST-to-ALT ratio (AAR).
resultsAmong participants (mean age 47.8 ± 13.0 years; 49.4% male), significant fibrosis was present in 18.4%, advanced fibrosis in 7.6%, and cirrhosis in 4.8%. FIB-6 showed AUROC values of 0.643 for significant fibrosis, 0.749 for advanced fibrosis, and 0.760 for cirrhosis. Among 30 patients with FibroScan-defined advanced fibrosis, FIB-6 identified 29 of 30 cases (96.7%) and had an NPV of 99.4%. Among 19 patients with FibroScan-defined cirrhosis, all cases were identified (19/19), resulting in an NPV of 100% (95% CI: 83.2-100.0); however, these estimates should be interpreted cautiously because of the low prevalence of advanced disease. Outcome-specific optimal cut-offs were identified using the Youden index (1.88 for significant fibrosis and 1.84 for advanced fibrosis/cirrhosis). While FIB-4 and NFS showed slightly higher AUROCs, differences were not statistically significant.
conclusionsFIB-6 demonstrates acceptable diagnostic performance, particularly for excluding advanced fibrosis and cirrhosis in MASLD. Although not superior to established scores, its high negative predictive value and simplicity suggest potential as a rule-out tool pending external validation.
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