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We read with great interest the study by Mózes et al on non-invasive tests (NITs) in non-alcoholic fatty liver disease (NAFLD)1 and commend the authors on their comprehensive individual patient data meta-analysis. The authors have confirmed that a two-step algorithm of fibrosis-4 index (FIB-4) and liver stiffness measurement with vibration controlled transient elastography (LSM-VCTE) has superior diagnostic performance for ruling in and ruling out advanced fibrosis and/or cirrhosis. Indeed, this concept has been demonstrated previously, including in our own work.2–4 However, we would like to highlight a few points for clarification.
First, the authors suggest a reduction in liver biopsies from 33% to as low as 19% when using the proposed rule-in cut-offs for cirrhosis, as summarised in Sankey diagrams. In our opinion, this comparative reduction in biopsies is not justified as the first diagnostic algorithm …
Contributors AM: manuscript preparation, study concept. EAT: manuscript preparation and critical review, study concept
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.
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