Two hundred forty-six patients with valid LSM acquisitions and satisfactory liver biopsy specimens were included in the analysis. Patients who failed LSM acquisitions had higher BMI (35.6 ± 6.3 versus 28.0 ± 4.5 kg/m2, P < 0.001) and waist circumference (114 ± 14 versus 94 ± 12 cm, P < 0.001). Valid LSM acquisitions were obtained in 62 of 63 (98.4%) patients with BMI less than 25 kg/m2, 114 of 117 (97.4%) patients with BMI 25 to 30 kg/m2, and 70 of 94 (74.5%) patients with BMI of 30 kg/m2 or higher.

The rate of successful acquisitions Alpelisib at the same BMI was similar in whites and Chinese. Thirty-one (12.6%) and 25 (10.2%) patients had advanced fibrosis and cirrhosis, respectively (Table 1). The LSMs of patients with F0, F1, F2, F3, and F4 disease were 5.7 ± 1.8, 6.8 ± 2.4, 7.8 ± 2.4, 11.8 ± 5.2, and 25.1 ± 17.1 kPa, respectively (P < 0.0001 by analysis of variance). Patients with F3 and F4 disease had significantly higher LSM than those with less fibrosis

(Fig. 1). Overall, the accuracy of transient elastography to detect F2 or higher, F3 or higher, and F4 disease was good, with areas under the receiver operating curve (AUROCs) of 0.84, 0.93, and 0.95, respectively (Table 2). The corresponding AUROCs were 0.87, 0.94, and check details 0.94, respectively, in the French cohort, and 0.84, 0.92, and 0.97, respectively, in the Chinese cohort. The best LSM cutoff for F2 or greater disease was 7.0 kPa (Table 2). The negative predictive value to exclude F2 or greater disease was 84% (95% confidence interval [CI], 78%–90%). Cutoff values of 5.8 kPa and 9.0 kPa had greater than 90% sensitivity and specificity to rule out and rule in F2 disease, respectively. The best cutoff for F3 or greater disease Thiamet G was 8.7 kPa (Table 2). The negative predictive value to exclude F3 or greater disease was 95% (95% CI, 91%–98%). Cutoff values of 7.9 and 9.6 kPa had greater than

90% sensitivity and specificity to rule out and rule in F3 disease, respectively. The best cutoff for F4 disease was 10.3 kPa (Table 2). The negative predictive value to exclude cirrhosis was 99% (95% CI, 98%–100%). The same cutoff value also had greater than 90% sensitivity to rule out cirrhosis. A cutoff value of 11.5 kPa had greater than 90% specificity to detect cirrhosis. Steatosis grade (P = 0.31), NAFLD activity score (P = 0.31), serum ALT (P = 0.39), and BMI (P = 0.29) did not influence LSM after adjusting for fibrosis stage (Fig. 2). Similarly, whites and Chinese had similar LSMs at the same fibrosis stage (P = 0.22). Discordance of at least two stages between transient elastography and histology was observed in 33 (13.4%) patients according to the cutoffs derived in this study. Transient elastography predicted a higher fibrosis stage in 30 cases and a lower fibrosis stage in three cases. Using cutoffs reported by Yoneda et al.,20 discordance was also observed in 33 (13.4%) patients.