PRISM MASLD Scorecard

Clinical Use Only — For use by registered NHS healthcare professionals. Not a substitute for clinical judgement. All outputs should be interpreted alongside full clinical context. MHRA Position A — no patient-identifiable data processed.

👤 Patient Profile

Patient ID

Click Generate ID for a new patient, or enter a previous Ref number from the consultation note for a returning patient.

Practice

Sex

Age (years)

Height (cm)

Weight (kg)

BMI (auto)

Previous Weight (kg)

Past Medical History

🩸 Type 2 Diabetes 💓 Hypertension 📊 Hypercholesterolaemia

Alcohol (units/week)

Smoker

AUDIT-C Score

0–12 scale

Hepatotoxic Medications

🧮 FIB-4 Index — Blood-Test Fibrosis Triage NICE NG49 primary care pathway

Auto-calculated from inputs below

AST (IU/L)

ALT (IU/L)

Platelets (×10⁹/L)

Previous ALT

Enter Age (above) + AST, ALT, and Platelets to calculate.

Formula: (Age × AST) ÷ (Platelets × √ALT) · <1.3 Low · 1.3–2.67 Indeterminate · >2.67 High risk (age ≥65: threshold 2.0)

Additional LFTs

ALP (IU/L)

GGT (IU/L)

Bilirubin (µmol/L)

🫀 FibroScan — Liver Stiffness (LSM) & Steatosis (CAP) VCTE · kPa / dB/m

Liver Stiffness Measurement (LSM) — MASLD/MASH thresholds

LSM (kPa)

FibroScan Date

ELF Score (if done)

<7.7 Low · 7.7–9.8 Mod · >9.8 High

Cirrhosis Confirmed?

Enter LSM kPa value to stage fibrosis.

MASLD thresholds: <7 kPa = F0/F1 · 7–10 kPa = F2 · 10–13 kPa = F3 · >13 kPa = F4

CAP Score (dB/m)

Range 100–400 · ≥288 = steatosis

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🫁 Hepatic Steatosis — CAP Staging Active stage from CAP score only · aetiology-independent

S0 · No Steatosis

CAP <248 dB/m

S1 · Mild

CAP 248–267 dB/m

S2 · Moderate

CAP 268–289 dB/m

S3 · Severe

CAP ≥290 dB/m

CAP elevation → hepatic fat burden (steatosis grade) Fibrosis staging (F0–F4) shown separately below from LSM kPa — interpret using aetiology-specific thresholds.

⚖️ Weight Management & Pharmacotherapy

On GLP-1 Agonist?

Specify Agent

Bariatric Surgery?

USS Steatosis Grade

Last USS (months ago)

Metabolic Parameters

HbA1c (mmol/mol)

If T2DM

Waist (cm)

Triglycerides (mmol/L)

HDL (mmol/L)

Clinic SBP (mmHg)

🏥 Hepatology Referral

Referral not yet made

Toggle when referral has been sent

Notes (optional)

⚠️

Hepatology Referral Indicated — Not Yet Made

Based on FibroScan/FIB-4 results, this patient meets criteria for hepatology referral. Please action or document reason for deferral.

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FIB-4 Index

Non-invasive blood-test fibrosis triage · NICE NG49 primary care pathway

FIB-4 is a validated non-invasive index calculated from Age, AST, ALT and platelet count. It is the recommended first-line fibrosis triage test in primary care (NICE NG49, BSG 2023). It does not require specialist input and should be calculated for all patients with suspected MASLD.

Formula: (Age × AST) ÷ (Platelets × √ALT)

Score	Risk Category	Action
<1.3	Low risk	Primary care monitoring. Repeat FIB-4 in 2–3 years or if metabolic control worsens.
1.3–2.67	Indeterminate	ELF test or repeat FIB-4 at 12 months. Consider hepatology pathway.
>2.67	High risk	Refer to hepatology or liver service. FibroScan / biopsy required.

Age adjustment: In patients aged ≥65 years, a threshold of 2.0 is used as the lower cut-off (BSG guidance) to reduce false positive referrals.

FibroScan — Liver Stiffness Measurement (LSM)

Vibration Controlled Transient Elastography (VCTE) · Values in kPa

FibroScan measures liver stiffness using VCTE at 50 Hz shear wave frequency. It is a reliable, non-invasive, reproducible measure of hepatic fibrosis. Results depend on BMI, ascites, operator experience, and probe type (M vs XL). Values should be interpreted alongside CAP, clinical context, and biochemistry.

LSM (kPa)	Fibrosis Stage	Interpretation	Action
<7 kPa	F0–F1	Minimal or no fibrosis	Primary care follow-up. No referral required.
7–10 kPa	F2	Moderate fibrosis	Referral to liver/hepatology clinic recommended.
10–13 kPa	F3	Severe fibrosis	Referral to hepatology. Closer monitoring required.
>13 kPa	F4	Cirrhosis likely	Urgent hepatology referral. HCC surveillance to be arranged.

Technical note: IQR/median ratio should be ≤30% for valid result. Failed or unreliable scans should be repeated. XL probe required for BMI >30 (or skin-to-capsule distance >25 mm).

CAP — Controlled Attenuation Parameter

Hepatic steatosis quantification via FibroScan · Values in dB/m

CAP is measured simultaneously with LSM on FibroScan devices (502 Touch, 530 Compact, 630 Expert). It uses attenuation of the ultrasound signal to quantify hepatic fat content. CAP is available on the 502 Touch with SmartScan capability and the 630 Expert with M5 probe.

CAP (dB/m)	Steatosis Grade	Hepatic Fat
<248	S0 — None/Minimal	<11% hepatocytes affected
248–267	S1 — Mild	11–33% hepatocytes affected
268–289	S2 — Moderate	34–66% hepatocytes affected
≥290	S3 — Severe	>66% hepatocytes affected

CAP ≥288 dB/m is the FibroScan-cited threshold for presence of steatosis. CAP values are influenced by BMI, fasting state, and probe type — interpret in full clinical context.

ELF Test — Enhanced Liver Fibrosis

Serum biomarker panel for liver fibrosis · NICE approved for NAFLD/MASLD pathway

The ELF test (Enhanced Liver Fibrosis) measures three serum markers of liver fibrosis: hyaluronic acid, procollagen III amino-terminal peptide (PIIINP), and tissue inhibitor of matrix metalloproteinase 1 (TIMP-1). It is recommended by NICE (NG49) as a second-line test after indeterminate FIB-4, or as an alternative non-invasive fibrosis marker.

ELF Score	Fibrosis Risk	Recommendation
<7.7	Low	Low risk of significant fibrosis — primary care management
7.7–9.8	Moderate	Moderate risk — consider hepatology referral
>9.8	High	High risk of significant fibrosis — hepatology referral indicated

ELF is typically requested via SNBTS or specialist laboratory. Results available within 2–5 working days. Not available in all primary care systems — check local pathways.

MASLD Diagnostic Criteria

Updated nomenclature — Delphi consensus 2023 · Replacing NAFLD/NASH

MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) requires: (1) Hepatic steatosis on imaging or histology, AND (2) at least one cardiometabolic risk factor:

BMI ≥25 kg/m² (≥23 in South/East Asian populations)
Fasting glucose ≥5.6 mmol/L, HbA1c ≥39 mmol/mol, or T2DM
BP ≥130/85 mmHg or on antihypertensive medication
Plasma triglycerides ≥1.70 mmol/L or on lipid-lowering treatment
HDL-C <1.0 (male) or <1.3 (female) mmol/L or on lipid-lowering treatment

Alcohol thresholds: MASLD requires alcohol <21 units/week (male) and <14 units/week (female). Above these thresholds = MetALD (metabolic + alcohol) or ALD territory.

MASH (Metabolic Dysfunction-Associated Steatohepatitis) = MASLD with active hepatocellular injury (equivalent to former NASH). Requires biopsy confirmation or surrogate markers.

Reference content served from CDMtools KV guidance store — editable without redeployment.
© Gupta R, Gupta A (2026) · CDMtools · cdmtools.co.uk · NICE NG49 · BSG MASLD 2023 · Echosens FibroScan Interpretation Guide 2025