HSI Calculator — Hepatic Steatosis Index
The Hepatic Steatosis Index uses ALT, AST, BMI and two clinical flags to estimate the likelihood of non-alcoholic fatty liver disease (NAFLD). Scores below 30 suggest fatty liver is absent; above 36 suggests it is present.
U/L
U/L
kg/m²
Biological sex
Type 2 diabetes
HSI > 36 — fatty liver likely; consult a physician
- 1
ALT ÷ AST ratio
35 ÷ 25 = 1,4 - 2
HSI: 8 × ratio + BMI
8 × 1,4 + 26 = 37,2
Kako radi ovaj kalkulator?
HSI = 8 × (ALT ÷ AST) + BMI, +2 for female sex, +2 for type 2 diabetes (Lee et al., 2010). Scores < 30 = fatty liver absent; 30–36 = indeterminate; > 36 = fatty liver likely. A non-invasive NAFLD screening tool — not a diagnosis; elevated scores need imaging and clinical evaluation.
Formula
How this is calculated
The Hepatic Steatosis Index was developed and validated by Lee et al. (Hepatology, 2010) as a non-invasive screening tool for hepatic steatosis (fat accumulation in the liver). The formula centres on the ALT/AST ratio — when the liver is fatty, ALT (which is more liver-specific) tends to rise relative to AST, producing a ratio above 1. Multiplying the ratio by 8 amplifies this signal in the score. BMI is added directly because excess body fat is a major driver of NAFLD. Female sex adds 2 points because hepatic fat distribution differs by sex; type 2 diabetes adds another 2 points because insulin resistance strongly promotes hepatic steatosis.
Cut-off values were established in the original study: an HSI below 30 indicates fatty liver absent (sensitivity and specificity validated against ultrasound); 30–36 is an indeterminate zone; above 36 indicates fatty liver likely. Importantly, the HSI is a screening tool — it does not diagnose NAFLD, quantify fibrosis, or replace imaging (ultrasound, MRI-PDFF) or liver biopsy. A high score should prompt clinical evaluation.
Results depend on accurate laboratory values. ALT and AST can be transiently elevated by exercise, alcohol, medications or other liver conditions (hepatitis B or C, autoimmune hepatitis), which would inflate the HSI independently of fat content.
Često postavljana pitanja
You need ALT (alanine aminotransferase) and AST (aspartate aminotransferase) from a standard liver function panel, plus your BMI. These are routine tests included in most comprehensive metabolic panels.
An HSI above 36 suggests hepatic steatosis is likely and warrants further evaluation — typically liver ultrasound or consultation with a gastroenterologist or hepatologist. It does not confirm NAFLD or indicate severity.
Yes. Many drugs elevate ALT or AST — including statins, NSAIDs, antibiotics and herbal supplements — which would raise the ALT/AST ratio and inflate the HSI. Tell your doctor about all medications before interpreting liver enzyme results.
Poznato i kao
TG we-Calculate Editorial Team. (2026). HSI Calculator — Hepatic Steatosis Index [Online calculator]. TG we-Calculate. https://we-calculate.com/hr/calculator/hsi-calculator
TG we-Calculate Editorial Team. "HSI Calculator — Hepatic Steatosis Index." TG we-Calculate. 2026. https://we-calculate.com/hr/calculator/hsi-calculator.
TG we-Calculate Editorial Team, "HSI Calculator — Hepatic Steatosis Index," TG we-Calculate, 2026. [Online]. Available: https://we-calculate.com/hr/calculator/hsi-calculator
@misc{wecalculate_hsi_calculator, title = {HSI Calculator — Hepatic Steatosis Index}, author = {{TG we-Calculate Editorial Team}}, howpublished = {\url{https://we-calculate.com/hr/calculator/hsi-calculator}}, year = {2026}, note = {TG we-Calculate} }
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