Diagnostic accuracy of the Fibrosis-4 (FIB-4) index for advanced liver fibrosis in Qatari patients with MASLD: Comparison with liver biopsy and FibroScan

Background : Metabolically-dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in populations with metabolic risk factors, and the liver fibrosis stage is the main determinant of long-term outcomes. The Fibrosis-4 (FIB-4) index is widely recommended as a first-line noninvasive test for fibrosis risk stratification; however, its diagnostic performance may vary across populations. Objective : To evaluate the diagnostic performance of the FIB-4 index for detecting advanced liver fibrosis in Qatari residents with MASLD, using liver biopsy as the primary reference standard and FibroScan as a secondary comparator. Methodology : This retrospective, cross-sectional diagnostic accuracy study included adults with MASLD evaluated at Hamad Medical Corporation in Qatar between January 2023 and December 2024. FIB-4 was calculated from routine laboratory parameters, and fibrosis was staged using the METAVIR (Meta-Analysis of Histological Data in Viral Hepatitis) scoring system. It is a histological scoring system used to grade necroinflammatory activity (A0–A3) and stage liver fibrosis (F0–F4). Advanced fibrosis was defined as METAVIR stage ≥F3. Diagnostic performance metrics and the area under the receiver operating characteristic curve (AUROC) were calculated at established cut-offs. Results : A total of 117 patients were included; 74 patients (63.2%) underwent liver biopsy, and 91 patients (77.7%) underwent FibroScan assessment. Advanced fibrosis was present in 21 patients (17.9%) on biopsy. At a FIB-4 cut-off of 1.3, sensitivity and specificity for detecting advanced fibrosis were 66.7% and 67.9%, respectively, compared with liver biopsy, with an overall accuracy of 67.6% and a negative predictive value of 83.7%. The AUROC for FIB-4 was 0.76. Conclusion : FIB-4 can be used as a first-line, accountable screening tool, followed by another confirmatory tool in high-risk patients.