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Non-invasive tests and advanced chronic liver disease in NAFLD: two steps forward and one step back?
  1. Avik Majumdar1,
  2. Emmanuel A Tsochatzis2,3
  1. 1AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  2. 2UCL Institute for Liver and Digestive Health, London, UK
  3. 3Royal Free Hospital Sheila Sherlock Liver Centre, London, UK
  1. Correspondence to Professor Emmanuel A Tsochatzis, UCL Institute for Liver and Digestive Health, London NW3 2QG, UK; e.tsochatzis{at}ucl.ac.uk

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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 …

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Footnotes

  • 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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