The Necroinflammatory Activity Grade is a measure of how much active inflammation and ongoing liver cell injury (hepatocellular necrosis) is occurring in the liver at the time of testing. It represents the current disease activity, not permanent scarring. While the Fibrosis Score or Stage reflects the amount of long-term liver damage or scarring (fibrosis), the Activity Grade reflects how active the underlying disease process is right now—how much the immune system and other injury processes are inflaming and damaging liver tissue.
This test is typically part of a FibroTest–ActiTest panel, which uses a mathematical model that combines several blood markers—such as ALT, AST, haptoglobin, apolipoprotein A1, α2-macroglobulin, GGT, and total bilirubin—to produce a numeric result (0.00 to 1.00). That number is then translated into a METAVIR necroinflammatory activity grade (A0 through A3).
The Necroinflammatory Activity Grade corresponds to the METAVIR grading system, a standardized method used to describe the degree of inflammation and hepatocellular damage in chronic liver disease:
| Activity Grade (a) | METAVIR Grade | Interpretation |
|---|---|---|
| a ≥ 0.00 and ≤ 0.17 | A0 | No activity (no inflammation) |
| a > 0.17 and ≤ 0.29 | A0–A1 | Minimal activity |
| a > 0.29 and ≤ 0.36 | A1 | Mild inflammation |
| a > 0.36 and ≤ 0.52 | A1–A2 | Mild to moderate activity |
| a > 0.52 and ≤ 0.60 | A2 | Moderate inflammation |
| a > 0.60 and ≤ 0.62 | A2–A3 | Moderate to severe activity |
| a > 0.62 and ≤ 1.00 | A3 | Severe necroinflammatory activity |
Always interpret your specific score using the reference range provided on your laboratory report and in conjunction with other liver health markers such as Fibrosis Score, ALT/AST, and imaging results.
This grade indicates no significant inflammation or hepatocellular injury. Your liver is currently stable, with no measurable immune or toxic attack on liver cells. This is a reassuring finding and typically means that your liver disease—if present—is inactive or well controlled.
A1 reflects low-grade inflammation and mild liver cell injury. This can occur in early or quiescent phases of chronic liver disease. Although the inflammation is minimal, consistent follow-up is important to ensure it does not progress. Lifestyle optimization (e.g., limiting alcohol, healthy diet, managing blood sugar and weight) and addressing underlying causes help preserve liver health.
This grade means that active inflammation is present, causing noticeable damage to liver cells. It suggests that the underlying disease (e.g., hepatitis B or C, fatty liver disease, or alcohol-related injury) is active and needs medical attention. Persistent inflammation at this level can drive the development of fibrosis (scarring) over time. Treatment to reduce inflammation—through antiviral therapy, metabolic correction, or alcohol cessation—is often recommended.
A3 indicates intense inflammation and hepatocellular necrosis, which significantly accelerates the risk of fibrosis progression and cirrhosis. This stage requires urgent evaluation and targeted intervention by a healthcare provider or hepatologist. The goal is to control or eliminate the cause of liver injury, reduce inflammation, and prevent irreversible liver damage.
Chronic liver inflammation is the engine driving fibrosis. The higher your Activity Grade, the more active the damage process, and the faster scarring may progress. Measuring the Necroinflammatory Activity Grade helps clinicians:
Detect whether your liver disease is currently active or inactive
Evaluate how effective treatment has been (e.g., antivirals, metabolic control)
Guide timing and intensity of therapy or monitoring
Avoid unnecessary liver biopsies by using a validated, non-invasive alternative
Tracking this score over time allows patients and doctors to see trends—whether inflammation is improving, stable, or worsening.
An increased Necroinflammatory Activity Grade can result from a variety of conditions that cause immune-mediated or metabolic injury to the liver, including:
Metabolic dysfunction-associated steatotic liver disease (MASLD/NASH)
Chronic hepatitis B or C infection
Alcohol-related liver injury
Drug-induced liver injury (DILI)
Autoimmune hepatitis
Other inflammatory or cholestatic conditions
Temporary increases can also occur from recent alcohol intake, acute viral infections, certain medications, or intense physical activity, which may raise liver enzymes without indicating permanent damage.
If your Activity Grade is low (A0–A1):
Maintain liver-healthy habits: balanced diet, physical activity, limited alcohol.
Recheck your liver profile periodically as recommended by your doctor.
If your Activity Grade is moderate (A2):
Address the cause (e.g., antiviral treatment for hepatitis, metabolic control for MASLD/NASH, alcohol cessation).
Monitor more closely with follow-up bloodwork or imaging (FibroScan®, ultrasound).
If your Activity Grade is high (A3):
Seek care from a hepatologist for specialized evaluation.
Intensive treatment is needed to stop or reverse the inflammatory process.
Continue regular monitoring for signs of fibrosis progression or liver decompensation.
The Necroinflammatory Activity Grade measures how active liver inflammation is right now—not the amount of scarring already present.
Grades range from A0 (none) to A3 (severe), corresponding to progressively greater inflammation and liver cell injury.
Higher grades require prompt management of underlying causes to prevent fibrosis and cirrhosis.
Results should always be interpreted together with Fibrosis Stage, liver enzyme levels (ALT, AST), and imaging studies.
Reducing liver inflammation through medical treatment and lifestyle change can slow or stop progression and even reverse early damage.
Your medical lab tests hold vital information about your health. Our tools help you understand what's going on and how to take action.
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Unlimited Plan Member since 2021
I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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Yes, you can. When entering values for the biomarker, you will see an "Edit Range" button. Click this button, and you'll have the option to enter a custom range.
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Abnormal Protein Band 1, Actin (Smooth Muscle) Antibody, Actin (Smooth muscle) Antibody (IgG), Albumin (via Protein electrophoresis), Alpha-1-Globulin, Serum, Alpha-2-Globulin, Serum, baski sore, Beta Globulin, Serum, Beta-1-Globulin, Serum, Beta-2-Globulin, Serum, Bile Acid, Bile Acids, Bilirubin Direct, Bilirubin Indirect, Cholinesterase, Serum, FIB 4 Index, FIB-4 Index, FIBROSIS SCORE, FIBROSIS STAGE, Gamma Globulin, Serum, Gamma-Glutamyl Transferase (GGT), Mitochondrial (M2) Antibody, NECROINFLAMMAT ACT GRADE, NECROINFLAMMAT ACT SCORE, Pre-Albumin, Prealbumin
