We’re pleased to share that we’ve introduced the Fibrosis-4 (FIB-4) index in Ontario as a convenient testing option, with promising clinical utility in defining NAFLD patients with increased risk of clinically significant fibrosis and reducing unnecessary biopsies. It’s a simple, non-invasive, and readily available marker for the screening of liver fibrosis3-4. The FIB-4 score is calculated from AST, ALT, platelet count and age7. This test can be highly beneficial for patients with the following conditions to be at high risk for NAFLD and advanced fibrosis5: obesity, metabolic syndrome, prediabetes, Type 2 Diabetes, hepatic steatosis on any imaging study, and persistently elevated ALT or AST levels (over 6 months).
HOW TO ORDER
To order FIB-4, all 4 component tests must be ordered. If any are missed, the FIB-4 cannot be performed:
- Write “FIB-4”, “FIB-4 index”, “Fib-4 Score”, “Fibrosis index”, or “Fibrosis score” in the “other tests” section of the standard OHIP requisition
- Write “Aspartate aminotransferase (AST/ SGOT)” in the other tests section
- Select Alanine aminotransferase (ALT/SGPT) on the OHIP requisition
- Select Compete Blood Count (CBC) on the OHIP requisition.
Your patients can then make an appointment at a LifeLabs Patient Service Centre (PSC), or walk in, for their blood draw. Patients must present the OHIP requisition requesting the FIB-4, CBC, ALT, and AST signed by a physician or healthcare provider. (Specimen collection requirements are similar to ALT, AST and CBC).
- The cost for this test is 10$ + 13$ for AST (unless patient meets criteria for insured AST). The FIB-4 index is not insured under OHIP. AST is only insured under OHIP when ordered by or on the advice of a physician with expertise in hepatic disorders.
REFERENCE RANGE AND RESULTS REPORTING
Turnaround time for results is within 1 day of specimen drop of. The following interpretive comment will be provided with FIB-4 index:
- < 1.30: Low risk for advanced liver fibrosis
- 30 – 2.67: Indeterminate risk for advanced liver fibrosis. May warrant further testing.
- >2.67: High risk for advanced liver fibrosis. Warrants further testing.
Clinicians should consider further follow-up with transient elastography or ELF blood test in persons with increased risk of advanced fibrosis and indeterminate or high FIB-4 score. For more information, please contact our Ontario Customer Care Centre at: 1-877-849-3637.
Dr. Mohamed Abouelhassan PhD FCACB
Clinical Biochemist, Medical-Scientific Department – Ontario, Medical Laboratory Director