Despite these limitations, an ideal alternative to liver biopsies has not been found. In this meta-analysis we assessed the diagnostic accuracy of the FIB-4 index as a non-invasive alternative to liver biopsy. The FIB-4 index is a simple and inexpensive noninvasive marker of liver fibrosis. Recently, the diagnostic value of the FIB-4 index in predicting the extent of fibrosis has been substantiated, and is even considered by some to be the best noninvasive index ; however, others have highlighted its weaknesses. The current study comprehensively analyzed the predictive power of the FIB-4 index using a meta-analysis of previously published studies. The area under the HSROC for the FIB-4 index was 0.78, and 0.79 and 0.89 for predicting significant and severe fibrosis, and cirrhosis, respectively. Thus, the summary diagnostic performance of FIB-4 for significant and severe fibrosis was nearly good, and for cirrhosis was nearly excellent. As the summary estimates of all cutoff values was deemed difficult to interpret and use in clinical practice, a Selumetinib subgroup analysis based on different cutoff values was performed. The recommended cutoff value for predicting significant fibrosis was between 1.45 and 1.62 based on the highest AUHSROC, but it still had suboptimal accuracy in excluding significant fibrosis. Fortunately, we found that the FIB-4 index with a cutoff value of 3.25 was suitable for identifying significant fibrosis. For severe fibrosis, the recommended cutoff value was between 1.45 and 1.65, and it has a suboptimal accuracy in identifying and excluding severe fibrosis. For cirrhosis, the recommended cutoff value was between 2.9 and 3.6, and the diagnostic performance was excellent. Thus, patient’s with a FIB-4 index above 3.6 can almost be diagnosed with cirrhosis, with a PLR=13.38. In terms of other noninvasive indexes, the APRI has the advantage of including only two inexpensive laboratory tests, which are performed routinely, and the FibroTest/Fibrosure is one of the most investigated and most frequently used tools for assessing liver fibrosis. The diagnostic performance of these two non-invasive indexes has been evaluated by meta-analysis. If we compare our meta-analysis of the FIB-4 index with these value of the FIB-4 index for predicting HBV-related fibrosis was also slightly better than that for HCV, although it was originally applied to HCV and HIV co-infection. Unfortunately, meta-analyses of other non-invasive tests for predicting HBV related fibrosis was not found, so comparison with the FIB-4 index was not possible. There are two strengths to the current meta-analysis. First, although the diagnostic performance of the FIB-4 index for HBVrelated fibrosis has previously been assessed by several studies, our evaluation combined the data from previously published work in a meta-analysis. Second, we searched the CNKI and CBMdisc databases that provided authoritative and comprehensive data from Chinese populations. This is important because the prevalence of HBV infection is much higher than that of HCV infection.