0%) patients with BMI of at least 30 kg/m2 and 26 (14.8%) patients with BMI less than 30 kg/m2. Thus, among 94 obese patients, 24 failed to have valid LSM acquisitions, and seven had discordant results. The overall success rate of transient elastography (valid Gemcitabine cost measurements plus correct classification) in patients with BMI of at least 30 kg/m2 was 67.0%. Among 37 patients with BMI of 35 kg/m2 or higher, 15 (41%) failed LSM acquisition, and two (5%) had discordance between LSM and histology. To avoid overfitting, Yoneda’s cutoffs were used to identify risk
factors for discordance. By univariate analysis, younger age, Chinese ethnicity, lower fibrosis stage, and shorter liver biopsy lengths were associated with discordance (Table 1). Discordance occurred in 25 of 144 (17.4%) patients with liver biopsy lengths smaller than 20 mm, compared with 8 of 102 (7.8%) patients with liver biopsy lengths 20 mm or greater (P = 0.031). Similarly, discordance occurred in 32 of 190 (16.8%) patients with F0F1F2
disease, but only 1 of 56 (1.8%) patient with F3 or higher disease (P = 0.002). Conversely, performance indices of transient elastography were not associated with discordance. Discordance occurred in 30 of 231 (13.0%) patients with at least 60% valid LSM acquisitions out of all measurements and 3 of 15 (20.0%) patients with valid OTX015 LSM acquisitions below 60% of all measurements (P = 0.43). Discordance occurred in 3 of 25 (12.0%) patients with IQR/LSM ratio above 0.3 and 30 of 221 (13.6%) patients with ratio below 0.3 (P = 1.0). By multivariate analysis, only liver biopsy length less than 20 mm (odds ratio, 2.7; 95% CI, 1.1–6.3; P = 0.024)
and F3 or greater disease (odds ratio, 0.084; 95% CI, 0.011–0.63; P = 0.016) remained independent factors associated with discordance. As shown in Table 3, AUROC Acetophenone of transient elastography was significantly higher than that of AST/ALT ratio, AST-to-platelet ratio index, FIB-4, NAFLD fibrosis score, and BARD score in the diagnosis of both advanced fibrosis and cirrhosis. Among the biochemical tests, the FIB-4 index was superior to AST/ALT ratio (P = 0.0008), AST-to-platelet ratio index (P = 0.017), and BARD score (P = 0.021) for the detection of F3 or greater disease, and superior to AST/ALT ratio (P = 0.0061) and BARD score (P = 0.0031) for the detection of cirrhosis. In an ‘intention-to-treat’ analysis, all 274 patients who underwent transient elastography and liver biopsy were analyzed, and the 28 patients in whom LSM could not be obtained were considered as not correctly classified. At the cutoff of 8.7 kPa, the negative predictive value of transient elastography in excluding F3 or greater disease remained high at 89.3% (Table 4). However, the positive predictive value was modest at 48.5%.