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Reply to: “Pitfalls in the non-invasive assessment of liver fibrosis with eLIFT-FMVCTE algorithm” and to “Application of the new eLIFT test for the non-invasive diagnosis of advanced liver fibrosis in people with type 2 diabetes”

Published:October 05, 2017DOI:https://doi.org/10.1016/j.jhep.2017.09.022
      We thank Wang, Zhang et al. for their interest in our paper, but their arguments deserve some comments. Pooling data from seven studies provided us with a very large population including 3,754 patients from 20 centres in France and one centre in Belgium. Large multicentre samples are more representative and thus more suitable for the development and validation of diagnostic tests than single centre populations, the latter being closely linked to intrinsic characteristics of the local population, as well as centre procedures and expertise. Our multicentre population was divided randomly to maintain its representativeness, which was comparable between the derivation and validation sets. We did not test total bilirubin and cholesterol because these parameters were not available for all patients in our dataset. However, blood fibrosis tests including bilirubin are frequently impaired either by false positive results linked to Gilbert’s syndrome, which affects around 5% of the general population, or by interlaboratory variability. Note also that cholesterol is included in only 2 of the 20 most popular blood fibrosis tests developed to-date
      European Association for Study of the LiverAsociacion Latinoamericana para el Estudio del Higado
      EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis.
      and is subject to therapeutic changes. The methodology we used to develop the eLIFT was specifically designed to obtain an easy-to-use blood fibrosis test, calculable at-a-glance and in one’s head without any computer. This design was validated by the good diagnostic accuracy observed for eLIFT in both derivation and validation populations. We agree that independent validation will reinforce our results and we therefore encourage further evaluations in large multicentre studies.

      Linked Article

      • A stepwise algorithm using an at-a-glance first-line test for the non-invasive diagnosis of advanced liver fibrosis and cirrhosis
        Journal of HepatologyVol. 66Issue 6
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          Chronic liver diseases (CLD) are very common: worldwide, an estimated 160 million people have chronic hepatitis C [1], 240 million have chronic hepatitis B [2], and 25% of the general population has non-alcoholic fatty liver disease (NAFLD) [3]. CLD can lead to a progressive accumulation of fibrosis in the liver which progressively evolves to cirrhosis and its life-threatening complications such as hepatocellular carcinoma (HCC), liver failure, variceal bleeding, or renal insufficiency. In 2012, driven by the growing worldwide burden of CLD, cirrhosis was responsible for more than 35 million years of lost life and thus became the eleventh leading cause of mortality among non-communicable diseases [4].
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      • Application of the new eLIFT test for the non-invasive diagnosis of advanced liver fibrosis in people with type 2 diabetes
        Journal of HepatologyVol. 68Issue 3
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          We read with great interest the manuscript by Boursier et al. on a stepwise algorithm using an at-a-glance first-line test for the non-invasive diagnosis of advanced liver fibrosis and cirrhosis.1 In their paper, the authors tried to answer an important question on the identification of chronic liver disease patients who need referral to hepatologists. Boursier et al. have developed an algorithm including the easy liver fibrosis test (eLIFT), a new simple and widely available blood test. It is used as a first-line procedure that selects at-risk patients who need further evaluation.
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      • Pitfalls in the non-invasive assessment of liver fibrosis with eLIFT-FMVCTE algorithm
        Journal of HepatologyVol. 68Issue 3
        • Preview
          We read with interest the study by Boursier et al. titled “A stepwise algorithm using an at-a-glance first-line test for the non-invasive diagnosis of advanced liver fibrosis and cirrhosis” recently published in the Journal.1 Using liver biopsy as reference in a cross-sectional study, the authors developed a stepwise algorithm for the detection of advanced liver fibrosis. This algorithm comprised of a first-line test called easy liver fibrosis test (eLIFT), followed by a second-line test of FibroMeter plus vibration controlled transient elastography (FMVCTE).
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