FIB-4 Sweep: Primary Care Case-Finder for Silent MASLD

An EHR add-on that computes the Fibrosis-4 score nightly from labs primary care already orders for every adult with metabolic risk factors, and hands clinicians a worklist of likely-undocumented MASLD patients who need fibrosis staging — now that two drugs are FDA-approved for advanced-fibrosis MASH. New evidence strengthens the case for making the sweep longitudinal rather than one-off, since MASLD progression is highly variable and the disease drives up to 38% of liver cancer cases. But it also confirms FIB-4's high false-positive rate in screening, so the tool treats FIB-4 strictly as a first-tier filter that must be confirmed by FibroScan before any referral or treatment decision.