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

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Derbala M.; Obeidat I.M.; Abualsuod R.; Draidi M.; Selim N.; Maatoug J.; Elkalamawi A.

Journal: Qatar Medical Journal

Publisher: HBKU Press

Publication Date: 2026

Volume / Issue: Volume 2026 / Issue 2

Article No.: 32

ISSN: 2538253

DOI: 10.5339/qmj.2026.32

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Derbala M., Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar, Theodore Bilharz Research Institute, Warraq Al Hadar, Egypt, Weill Cornell Medical College, Ar-Rayyan, Qatar; Obeidat I.M., Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar; Abualsuod R., Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar; Draidi M., Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar; Selim N., Community and Preventive Medicine Department, Primary Health Care Corporation, Doha, Qatar; Maatoug J., Community and Preventive Medicine Department, Primary Health Care Corporation, Doha, Qatar, Faculty of Medicine of Sousse, Sousse University, Sousse, Tunisia; Elkalamawi A., Epidemiology-Medicine, Lincoln University, Kota Bharu, Malaysia

Abstract

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. © 2026 Derbala, Obeidat, Abualsuod, Draidi, Selim, Maatoug, et al., licensee HBKU Press.

Keywords

accuracy; FIB-4; FibroScan; Fibrosis-4 index; liver biopsy; MASLD; adult; Article; controlled study; cross-sectional study; diabetes mellitus; diagnostic accuracy; dyslipidemia; human; human cell; human tissue; hypertension; liver fibrosis; major clinical study; medical record review; metabolic fatty liver; necroinflammation; obese patient; obesity; performance indicator; predictive value; Qatar; Qatari; receiver operating characteristic; retrospective study; risk factor; sensitivity and specificity; transient elastography

Citation Information

Scopus Citations: 0

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