Understanding Your METAVIR Score

Using the METAVIR System to Understand Your Liver Biopsy

liver biopsy
An autopsied liver showing a dense network of scar tissue, called cirrhosis. A biopsy from this liver would probably score F4.. CDC/ Dr. Edwin P. Ewing, Jr.

Sometimes it seems we're surrounded by all kinds of scores. For example, if you're buying a car or house, you'll be very familiar with your credit score. When you watch a game, you keep track of your team's score. In high school or college, you're often judged by another type of score, your GPA (grade point average). Similarly, if you have chronic hepatitis C, you may also have a score: the METAVIR score, which assesses the health of your liver.

What Is a METAVIR Score?

Liver fibrosis, which may lead to cirrhosis of the liver, is a hallmark sign of chronic liver disease. Therefore, physicians will want to evaluate the presence and stage of fibrosis in any patient with a chronic liver disease, including hepatitis C. Blood tests are limited in their ability to evaluate liver fibrosis, and a liver biopsy is the best way to gain insight into the health of the liver.

The METAVIR score provides a model for interpreting a liver biopsy. When this biopsy is performed, doctors need a reliable way to quantify what is seen under the microscope. This scoring system assigns two standardized numbers: one to represent the degree of inflammation and the other the degree of fibrosis.

What Does My METAVIR Score Mean?

The fibrosis is graded on a 5-point scale from 0 to 4. The activity, which is the amount of inflammation (specifically, the intensity of necro-inflammatory lesions), is graded on a 4-point scale from A0 to A3.

Fibrosis score:
F0 = no fibrosis
F1 = portal fibrosis without septa
F2 = portal fibrosis with few septa
F3 = numerous septa without cirrhosis
F4 = cirrhosis

Activity score:
A0 = no activity
A1 = mild activity
A2 = moderate activity
A3 = severe activity

Why Is a METAVIR Score Helpful?

Your METAVIR score is one of many "tools" your doctor can use to help determine your treatment and monitor your progress.

Sometimes a score of two or greater suggests that treatment should begin. This is not always the case, because individualized treatment can also be recommended for people with a lower score.

Like most things, the METAVIR system has its strengths and weaknesses. Other scoring systems are available, such as the Knodell score (also called the histologic activity index, or HAI). However, the METAVIR score is simple to use and is popular in many clinics.

Generally, an understanding of the stage of fibrosis is valuable for guiding treatment decisions. For example, the level of fibrosis can indicate the likelihood of treatment response (more advanced cases will usually have a poorer response to treatment). In addition, if fibrosis progresses slowly, it may be preferable to wait before starting treatment with antiviral therapy. And finally, using the METAVIR system, doctors can gain insight and make an estimation about when cirrhosis may develop. 

Related Articles


Kaplan MM, Bonis PA. "Histologic Scoring Systems for Chronic Liver Disease." UpToDate. Accessed: March 29, 2009.

Malet, PF. "Chronic Hepatitis." ACP Medicine. Accessed: April 1, 2009.

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