This page is a quick reference for GPs and referring clinicians: how to send a referral, and links to commonly used calculators for patients with liver disease and hepatitis. Each calculator briefly notes what it estimates and the information it needs — follow the link through to run the calculation.

How to refer

Please get in touch if you have a question about a patient. Referrals can be sent using the contact details on our Contact page, and urgent referrals are welcome — call or message us directly for anything time-sensitive.

Liver fibrosis & risk calculators

These non-invasive scores use routine blood results (and sometimes age, sex or BMI) to estimate liver fibrosis risk or hepatocellular carcinoma (HCC) risk, without requiring a liver biopsy. They’re a useful first-pass tool for deciding who needs further assessment such as FibroScan or specialist referral.

APRI (AST to Platelet Ratio Index)

Estimates liver fibrosis risk, particularly in patients with hepatitis C, using AST and platelet count. As a rough guide: scores below 0.5 suggest a low likelihood of significant fibrosis, 0.5–1.5 is indeterminate and may warrant further assessment, and above 1.5 suggests a higher likelihood of advanced fibrosis.
Open the APRI calculator (MDCalc) →

FIB-4 Score

A widely used fibrosis estimate for chronic liver disease, including hepatitis B, hepatitis C and fatty liver disease, using age, AST, ALT and platelet count. Roughly: below 1.3 suggests lower risk, 1.3–2.67 is indeterminate, and above 2.67 suggests higher risk of advanced fibrosis.
Open the FIB-4 calculator (MDCalc) →

NAFLD Fibrosis Score

Estimates the likelihood of advanced fibrosis in patients with fatty liver disease (MASLD/NAFLD), using age, BMI, diabetes status, AST/ALT ratio, platelet count and albumin.
Open the NAFLD Fibrosis Score calculator (MDCalc) →

REACH-B Score

Estimates hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B, using age, sex, ALT, HBeAg status and viral load. Useful for guiding surveillance decisions — antiviral treatment decisions should still follow standard hepatitis B treatment criteria.
Open the REACH-B calculator (MDCalc) →

REAL-B Score

Estimates HCC risk in patients with chronic hepatitis B who are already receiving antiviral treatment, using factors including age, sex, cirrhosis status and treatment history — useful for guiding the intensity of ongoing surveillance.
Open the REAL-B calculator →