P18 The great fatty liver showdown: comparison of FIB-4 score to liver stiffness measurement (LSM) on fibroscan in metabolic-dysfunction associated steatosis liver disease (MASLD)

<h3>Introduction</h3> The FIB-4 score is a widely used non-invasive tool for assessing liver fibrosis, with scores ≥2.67 indicating an 80% positive predictive value and scores &lt;1.30 indicating a 90% negative predictive value. It is widely accepted that for patients with FIB-4 ≥1.30 (if 35–65 years old) and patients with FIB-4 ≥2.0 (if &gt;65 years old), Fibroscan should be performed for secondary risk assessment to further risk stratify liver disease severity. This study aims to compare FIB-4 results with LSM obtained via Fibroscan to determine their correlation and effectiveness in diagnosing advanced fibrosis. <h3>Methods</h3> We retrospectively reviewed 254 patients attending a nurse-led MASLD clinic over a 9-month period (May 2024 – January 2025). Exclusion criteria included &gt;52 weeks between blood tests and Fibroscan, and age &lt;35 years. We analysed data on the remaining 207 patients, to include age, FIB-4 score, LSM, interquartile range (IQR) and alcohol intake. FIB-4 scores were calculated using standard formulas, and LSM was measured using Fibroscan. Cut off for a low FIB-4 score was &lt;1.30 if 35–65 years and &lt;2.0 if over 65 years. Correlation analysis was performed, and results were stratified by fibrosis stages (F0-F4). <h3>Results</h3> The correlation coefficient between FIB-4 and Fibroscan results was 0.1720 (p=0.0132), indicating a weak but statistically significant correlation. When analyzing patients with low FIB-4 scores, 37% had advanced fibrosis (F2-F4, defined by a LSM &gt;8kPa) that would have been missed if relying solely on FIB-4. Among patients with F2-F4 fibrosis, 32% had low FIB-4 scores, and 68% had indeterminate or high scores. For patients with F4 fibrosis (defined by a LSM &gt;12kPa), 31% had low FIB-4 scores, and 69% had indeterminate or high scores. Further analysis showed that excluding patients over 65 years improved the correlation coefficient to 0.2340 (p=0.0046), suggesting non-invasive measures are less accurate in older populations. There was no statistical difference between the groups when assessing the IQR or alcohol intake at the time of Fibroscan. <h3>Conclusion</h3> The study demonstrates a weak correlation between FIB-4 scores and LSM measurements, with a significant proportion of patients with advanced fibrosis being missed by FIB-4 alone. This highlights the importance of assessing the full clinical picture and determining the need for additional diagnostic tools to risk stratify those in whom there is a high clinical suspicion of fibrosis despite low FIB-4 score.