{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:50:47Z","timestamp":1791348647840,"version":"4.3.1"},"reference-count":96,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Steatotic liver disease (SLD) is highly prevalent, and fibrosis stage is the strongest determinant of liver\u2010related outcomes, hepatocellular carcinoma and mortality. Liver biopsy remains the reference standard for staging, but it is invasive, subject to sampling and observer variability. These limitations have accelerated the use of noninvasive tests (NITs) across various settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This review summarizes the past, present and future of the Fibrosis\u20104 (FIB\u20104) index in SLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed the development of serum\u2010based fibrosis assessment, validation of FIB\u20104 across SLD subtypes, its incorporation into clinical pathways, real\u2010world performance and potential role in precision therapy and longitudinal risk assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Initially derived in patients with HIV\/hepatitis C coinfection using age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, FIB\u20104 has since been validated across SLD populations. FIB\u20104 generally provides moderate discrimination for advanced fibrosis and high negative predictive value (NPV) when used with dual thresholds and age\u2010adjusted cutoffs. Modern care pathways operationalize FIB\u20104 as the first\u2010line triage test, followed by transient elastography or another second line test for indeterminate or elevated results, with specialty referral and selective biopsy reserved for diagnostic uncertainty or discordant testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the precision therapy era, FIB\u20104 remains a scalable front\u2010door test but should not serve as a stand\u2010alone selector for drug eligibility; confirmatory staging is required to identify F2\u2013F3 disease and exclude cirrhosis. Future directions include trajectory\u2010based monitoring, integration with elastography and multi\u2010analyte biomarkers, and selective layering of genetic risk to refine prognosis in intermediate and high\u2010risk strata.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.71037","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:20:21Z","timestamp":1791346821000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Review Article: Fibrosis\u20104 Index in Steatotic Liver Disease\u2014Past, Present and Future"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1875-1200","authenticated-orcid":false,"given":"Kriti","family":"Soni","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine Virginia Commonwealth University School of Medicine  Richmond Virginia 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