Considerations and clinical utility of referral pathways for early detection of liver disease in at-risk populations

Table 3 Recommended primary non-invasive tests for screening for liver disease in at-risk populations

	Rule out	Rule in
2021 EASL NIT clinical practice guideline	FIB-4: < 1.3	FIB-4: ≥ 2.67
2021 AGA clinical care pathway	FIB-4: < 1.3 (2.0 aged ≥ 65 years)	FIB-4: ≥ 2.67
2023 AASLD practice guidance	FIB-4: < 1.3 (< 2.0 aged ≥ 65 years)	FIB-4: ≥ 2.67
2024 EASL-EASD-EASO clinical practice guideline	FIB-4: < 1.3 (2.0 aged ≥ 65 years)	FIB-4: ≥ 2.67
2025 APASL clinical practice guideline	FIB-4: 1.3 NFS1	FIB-4: ≥ 2.67 NFS1

¹No cut-offs have been provided in the guideline.

FIB-4: Fibrosis-4; NFS: Nonalcoholic fatty liver disease fibrosis score; EASL: European Association for the Study of the Liver; NIT: Non-invasive test; AGA: American Gastroenterological Association; EASD: European Association for the Study of Diabetes; EASO: European Association for the Study of Obesity; APASL: Asian Pacific Association for the Study of Liver; AASLD: American Association for the Study of Liver Diseases.