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With interest we read the letter entitled ‘Ruling in and ruling out with elastography in compensated advanced chronic liver disease’ by Agustin et al1 to our study ‘Algorithm to rule-out clinically significant portal hypertension combining Shear-wave elastography of liver and spleen: a prospective multi-centre study’.2 Indeed, we would like to thank our colleagues for their interest in our study and deciphering the strengths and weaknesses of this study. Besides acknowledging the merits of the study, the colleagues commented on the selection of patients regarding severity and aetiology of advanced chronic liver disease (ACLD), as well as the clinical importance of ruling out or ruling in clinically significant portal hypertension (CSPH).
The criticism about the selection of patients stimulated us to perform new calculations. Even though the algorithm was calculated including patients with decompensated ACLD (dACLD), it performed much better in …