The Necroinflammatory Activity Score—often part of the FibroTest-ActiTest panel—estimates the degree of active inflammation and hepatocellular injury occurring in the liver. Unlike fibrosis (scarring), which reflects chronic and structural damage, the necroinflammatory score reflects ongoing liver cell injury and inflammation, which can fluctuate over time depending on disease activity or recent insults to the liver.
This score is based on a combination of routine blood test results, including ALT, AST, total bilirubin, haptoglobin, apolipoprotein A1, α2-macroglobulin, and GGT, and then processed through an algorithm to produce a quantitative index (ranging from 0.00 to 1.00) that corresponds to METAVIR grades A0 through A3. It provides a non-invasive alternative to liver biopsy for assessing inflammation in chronic liver diseases such as fatty liver disease (MASLD/NASH), hepatitis B, hepatitis C, and alcohol-related liver injury.
How It’s Reported (Score Ranges and METAVIR Grades)
The Necroinflammatory Activity Score (ActiTest) typically maps to the METAVIR activity grading system, which categorizes the degree of necroinflammation as follows:
| Activity Score (a) | METAVIR Grade | Interpretation |
|---|---|---|
| a ≥ 0.00 and ≤ 0.17 | A0 | No activity (no significant 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 inflammation |
| a > 0.52 and ≤ 0.60 | A2 | Moderate activity |
| 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 result using your lab’s reference ranges and the context of your other liver tests (e.g., Fibrosis Score, ALT/AST, imaging results).
Understanding Your Result
Low or Minimal Activity (A0–A1)
This result indicates little to no active inflammation in your liver. Liver cells are largely intact, and there is no significant ongoing injury. This is a reassuring result, suggesting the disease is stable or inactive. Regular monitoring and continued liver-healthy habits—such as limiting alcohol, maintaining a healthy body weight, and managing metabolic risk factors—are recommended to prevent future inflammation.
Mild to Moderate Activity (A1–A2)
This range reflects active inflammation with mild-to-moderate liver cell injury. While fibrosis may still be limited, the inflammation signals ongoing damage that, if left unchecked, can promote scarring over time. At this stage, it’s crucial to address the underlying cause—for example:
-
Starting or optimizing treatment for hepatitis B or C
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Implementing weight loss and metabolic control strategies for MASLD/NASH
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Eliminating alcohol or other hepatotoxic substances
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Adjusting medications that may impact liver function
Lifestyle modification and medical treatment can reduce inflammation and potentially reverse early damage.
Moderate to Severe Activity (A2–A3)
A higher score means significant ongoing inflammation, which puts you at increased risk for progressive fibrosis and cirrhosis. The liver is actively inflamed, and hepatocytes (liver cells) are being damaged faster than they can repair. This level of activity typically requires specialist management—often under the care of a hepatologist—to identify and treat the underlying cause, monitor liver function closely, and prevent further progression.
Why It Matters
Inflammation is a key driver of fibrosis. The more active the necroinflammatory process, the faster scarring can accumulate. By quantifying this activity, the Necroinflammatory Activity Score helps clinicians:
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Detect active liver inflammation early, even before symptoms appear
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Distinguish between quiescent and active disease phases
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Monitor response to antiviral or metabolic treatments
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Reduce the need for liver biopsy
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Guide treatment decisions and follow-up frequency
Factors That Can Influence the Score
Certain conditions can temporarily raise or lower your score without reflecting permanent liver damage. These include:
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Acute infection or inflammation (including viral illnesses)
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Recent alcohol consumption
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Medication or supplement use that affects liver enzymes (e.g., acetaminophen, statins, herbal products)
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Strenuous exercise within 48 hours before testing
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Hemolysis, Gilbert syndrome, or cholestasis affecting bilirubin and haptoglobin levels
For accurate interpretation, your provider will review your clinical history, medications, and lifestyle factors.
What to Do Next
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If your score is low: Maintain liver-healthy habits, and recheck your liver profile periodically.
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If your score is mild-to-moderate: Work closely with your clinician to identify triggers or causes of inflammation and begin treatment or lifestyle interventions.
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If your score is high: You may need referral to a hepatologist, additional imaging (like FibroScan®), or consideration of antiviral, metabolic, or immunomodulatory therapy depending on the cause.
Key Takeaways
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The Necroinflammatory Activity Score measures current liver inflammation—a marker of disease activity, not just long-term damage.
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It helps distinguish between stable and active disease states, guiding both treatment urgency and monitoring frequency.
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Low scores (A0–A1) mean minimal inflammation; higher scores (A2–A3) indicate significant ongoing injury and need for closer care.
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Addressing the root cause—whether viral, metabolic, or alcohol-related—can lower inflammation and slow or stop fibrosis progression.
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