This page includes information about the ELF and Fib-4 fibrosis scoring systems.
Fibrosis means scarring of the liver. It is a stage of long-term liver disease. A liver with fibrosis can still do all its usual jobs. But if the damage continues it can cause cirrhosis.
On this page:
What are fibrosis scoring systems and when are they used?
Fibrosis scoring systems bring together a group of different test results. Doctors sometimes use them look at how much scarring there is in your liver. They might also talk about this as the stage of fibrosis.
Fibrosis scoring systems are only used for people with risk factors for liver disease. They have not been shown to be helpful for people who do not have these risk factors.
No test for liver fibrosis is perfect. Doctors will look at your liver fibrosis test alongside other test results and information about you. They will use this to work out your individual risk of having a liver problem and what should happen next.
The amount of fibrosis in your liver can change over time. It can get better as well as worse. So you might be asked to have these tests again to see if anything has changed or to monitor your condition.
Not everyone will have these tests. You might have both of them, just one, or a different type of test such as a VCTE (FibroScan). This will depend on your condition, and the policy at your hospital.
Fib-4
Also called Fibrosis-4 index
The Fib-4 index is a calculation. It uses your age and the results of some of your blood tests to give an indication of the amount of scarring (fibrosis) in your liver.
Having a FIB-4 test
A Fib-4 index can usually be worked out from the results of a liver blood test. This is a very common test. If you have recently had it, your doctor might be able to use those results.
If not, you will have a blood test. A small amount of blood will be taken, usually from your arm.
Some medicines can affect your results. So tell your doctor about any medicines you are taking. This includes over the counter medicines, herbal and natural remedies, and supplements.
Once your doctor has your blood test results, they can use a formula to work out your Fib-4 index.
What will be tested
The test looks at your:
- age in years. It is most reliable if you are between 35 and 65 years old
- AST level
- ALT level
- Platelet count
AST and ALT are enzymes that are made in your liver. Your platelet count is a test of how well your blood clots if you get a cut. You can find out more about all of these on the liver blood tests page.
Understanding the results and what happens next
The Fib-4 index gives you a result between 0 and 6. Based on this number you will usually be told if your fibrosis is mild, moderate or severe.
The exact cut off point for each stage can be a bit different for different people. It can also depend on where you have your tests. This information is just a guide. Speak to your medical team for a personal explanation of your score and what it means.
0-2 – Mild fibrosis
3-4 moderate cirrhosis
5-6 severe cirrhosis/ cirrhosis
If your fibrosis is mild, you probably won’t need to see a specialist. But it is a good idea to make some changes in your everyday life to help your liver to heal itself. You can find out more about eating, drinking and keeping active.
If you have moderate or severe fibrosis you are likely to be referred to a specialist or have more detailed tests.
ELF
Also called: enhance liver fibrosis test/score
The ELF test is a blood test. The result can tell you if you are likely to have fibrosis and how severe it might be.
Having an ELF test
The ELF test is not part of a standard liver blood test. You might need to have a blood sample taken for the ELF test or as part of a full liver screen.
A small blood sample will be taken, usually from your arm. The ELF test looks at several things, but these tests can all be done from one tube of blood.
What will be tested?
- Hyaluronic acid (HA)
- A protein called procollagen III amino terminal peptide (PIINP)
These are both involved in forming scars (fibrosis)
- An enzyme called matrix metalloproteinase 1 (TIMP-1).
High levels of TIMP-1 can make it hard for your liver to clear away scar tissue.
Understanding your results and what happens next
The ELF scoring system will give you a number. The higher the number, the more fibrosis your liver is likely to have.
Based on your number, you might be told that your fibrosis is mild, moderate, severe or cirrhosis.
In general, if your ELF score is below 9.8 your fibrosis is mild or moderate. In this case your GP will look after your care. You may be told to make some changes in your life to help your liver repair that damage. You can find out more about eating, drinking and keeping active here.
If your score is 9.8 or higher then you could have more severe fibrosis. You should be referred to a specialist for more tests.
The numbers on this page are a rough guide. The exact numbers used for each of these stages can be a bit different depending on where you have the test. So it is very important to talk to your medical team for personal information about what your results mean.
Questions to ask your medical team
Fibrosis scoring systems and complicated and exactly what they mean is different for everyone. If you have a follow up appointment, it can help to write down some questions in advance to help you get the most out of it.
Here are some suggestions for questions to ask your doctor or nurse:
- What stage is my fibrosis? How sure are you about that?
- Should I have any other tests?
- Should I have this test again to see if anything changes?
- What should happen next – what are my options?
- If I need to make some changes in my life, is there any help or support available?
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This content was last reviewed: July 2025
Our expert reviewers:
We would like to thank everyone who helped with creating and reviewing this page. Including Professor Stephen Ryder, Consultant Hepatologist at Nottingham University Hospitals NHS trust. And all our patient reviewers.
Find out how we make our patient information.
Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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