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What is Stage 4 Fibrosis of the Liver?

Liver fibrosis is a serious health problem associated with significant morbidity and mortality.

What is Stage 4 Fibrosis of the Liver?

It is the final common route in the evolution of multiple liver pathologies, whose last stage is cirrhosis. Fibrosis occurs as a result of an exaggerated response of the liver to chronic aggressions that, regardless of their origin, cause tissue damage. These alterations in the hepatic architecture result, finally, in a functional deterioration.

The main diseases that cause hepatic fibrosis are hepatitis C and excessive alcohol consumption, but many others complete the list of possible etiologies.

What is Stage 4 Fibrosis of the Liver?

The speed of progression of fibrosis has a wide interpersonal variability. Factors such as age over 50 years, male sex, or high alcohol consumption have been related to the evolution of liver fibrosis. At present, there would be therapeutic agents that could stop the development of hepatic fibrosis, although the resolution of the condition involves eliminating the underlying etiology. Treatments with interferon, phlebotomies or corticosteroids, depending on the etiology of fibrosis, have been shown to be potentially effective.

Detecting the presence of liver fibrosis, quantify its magnitude and control its progression is essential for the appropriate decision making related to clinical management according to the prognosis, survival and treatment of patients with chronic liver disease. Determining the best time to start treatment, which the patients will benefit or assess the response to it, are crucial for the prognosis of these patients.

Currently, liver biopsy is the diagnostic technique of choice to determine the liver fibrosis stage, considering it as the reference study for the diagnosis of liver fibrosis. Liver biopsy is usually performed percutaneously with ultrasound follow-up.

In patients with ascites or coagulopathies due to alcoholic liver disease, the risk of complications related to post-puncture hemorrhage is more frequent. The transjugular biopsy would be the alternative way to reduce the risk of them.

As a reference test, it has some disadvantages such as its invasive character, inter and intraobserver variability, regular acceptance by the patient, high cost, potential severe complications, and death. The size of the biopsy sample ranges between 1 and 4 cm in length and between 1.2 and 2 mm of diameter. The histopathological analysis of the biopsy reports on liver fibrosis, necroinflammatory activity, the degree of hepatic steatosis and on the etiology of the liver disorder.

There are several histopathological scales to quantify the degree of liver fibrosis by biopsy. The most commonly used is METAVIR, which measures fibrosis on a scale of 0 to 4.


Stage 0 = Absence of fibrosis

Stage 1 = Portal fibrosis without septa

Stage 2 = Portal fibrosis with some septa

Stage 3 = Numerous septa without cirrhosis

Stage 4 = Cirrhosis

Significant fibrosis is considered when the stage of fibrosis is equal to or greater than S2 and advanced fibrosis, when a fibrosis stage equal to or greater than S3 is reported. The detection of patients in stage S2 or higher entails important clinical implications since in most cases, the threshold for initiating treatment is considered.

Due to the characteristics and limitations previously described on biopsy, non-invasive laboratory and imaging techniques have been developed as potential alternative methods for the diagnosis of hepatic fibrosis.

In recent years, the interest in identifying and describing hepatic fibrosis through the use of non-invasive markers has been increasing.

The fibrosis can be determined in two non-invasive ways; one of them is based on a biological approach, by quantifying markers in serum and the second in a physical approach, measuring the rigidity of the liver. Both are complementary and although there is no ideal marker for fibrosis, molecules have been identified that can be useful even when combined.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 1, 2021

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