Liver risk check
BARD score calculator
The BARD score adds up three things, BMI, the AST/ALT ratio and diabetes, to sort people who already have fatty liver disease into a lower or higher chance of advanced liver scarring (fibrosis). It is a research score, and FIB-4 is the recommended first test.
Your numbers
AST and ALT come from a liver panel or comprehensive metabolic panel. Nothing you enter leaves this page.
What you will see
Your BARD score from 0 to 4, the points for each item, and what the 0 to 1 and 2 to 4 groups meant in the study that built it.
Educational only, not medical advice. The score cannot diagnose liver disease.
Source
Harrison SA et al., Gut 2008. Points and the 2 to 4 group as printed in the paper's abstract.
Validated in
827 adults with fatty liver disease (NAFLD) at two US tertiary medical centres, with a median BMI of 33; 35% had diabetes and 24% had advanced scarring.
Limits
Only for people who already have fatty liver disease. It sorts people into two groups and gives no percentage risk. Most people with 2 or more points do not have advanced scarring. In a later US comparison it was less accurate than FIB-4, which the AASLD recommends as the first test.
How the score works
The score has three items and runs from 0 to 4 (Harrison 2008):
| Item | Points |
|---|---|
| BMI of 28 kg/m² or more | 1 |
| AST/ALT ratio of 0.8 or more | 2 |
| Diabetes | 1 |
The name comes from the items: BMI, AST/ALT Ratio and Diabetes. The authors chose these three after a logistic regression on their patients and gave the ratio double weight (Harrison 2008). You can work the ratio out yourself or with the AST/ALT ratio calculator.
What 0 to 1 and 2 to 4 mean
In the study that built it, a score of 2 to 4 went with an odds ratio of 17 for advanced scarring (95% confidence interval 9.2 to 31.9) compared with a score of 0 or 1, and the negative predictive value was 96% (Harrison 2008). In plain words: in that group, most people with 0 or 1 point did not have advanced scarring. The authors concluded the score can help rule advanced scarring out, especially in people without diabetes (Harrison 2008).
The high group is less telling. In a later US study of 541 adults with fatty liver disease, about 1 in 3 people with a score of 2 to 4 had advanced scarring (stage 3 or 4) on biopsy (Shah 2009). That is why a score of 2 or more is a reason for another test, not a diagnosis.
BARD and FIB-4
The same US study compared eight simple scores on the same patients. FIB-4 separated advanced scarring best (area under the curve 0.802), and BARD scored 0.70 (Shah 2009). The American Association for the Study of Liver Diseases recommends FIB-4 as the first test for advanced scarring in fatty liver disease, followed by a liver stiffness scan or an ELF blood test when FIB-4 is 1.3 or higher (AASLD 2023). If you have your age and a platelet count as well, start with the FIB-4 calculator. The NAFLD fibrosis score uses BMI, diabetes and the AST/ALT ratio too, plus age, platelets and albumin, and the APRI calculator was built for hepatitis C.
Why diabetes and BMI count
Fatty liver disease is more common in people with overweight or obesity and type 2 diabetes, and it usually has no symptoms (NIDDK). In the BARD study, insulin resistance was present in 91% of patients and diabetes in 35% (Harrison 2008). Because two of the three items describe your body and medical history rather than your liver, a high score in someone without fatty liver disease means little: the score was only tested in people who already had the diagnosis.
Do I have fatty liver disease?
The BARD score does not tell you that. Liver fat is usually found on an ultrasound or other scan. Indexes such as the hepatic steatosis index and the fatty liver index estimate the chance of liver fat, not scarring. For the full picture, read our fatty liver disease guide.
Sources
- Harrison SA, Oliver D, Arnold HL, Gogia S, Neuschwander-Tetri BA. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57(10):1441-1447. PMID 18390575. pubmed.ncbi.nlm.nih.gov/18390575/
- Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104-1112. doi.org/10.1016/j.cgh.2009.05.033
- Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. doi.org/10.1097/HEP.0000000000000323
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Nonalcoholic Fatty Liver Disease (NAFLD) and NASH. www.niddk.nih.gov/health-information/liver-disease/nafld-nash
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.