We appreciate the interest in our study by Majumdar and Tsochatzis1 and welcome the opportunity to provide some clarifications. The literature to date has examined non-invasive test (NIT) algorithms to rule-in and rule-out advanced fibrosis (AF). The main use of such algorithms is to identify those at low risk of AF who can be managed in primary care. We propose an algorithm2 where the rule-out cut-offs remain optimised for AF, whereas the rule-in cut-offs are optimised for cirrhosis. The false-negative (FN) rate of 10% in our proposed algorithm refers to the FN rate for AF and not cirrhosis as Majumdar and Tsochatzis state in their letter.1 Only 18/570 (3%) of patients with cirrhosis are missed using our proposed algorithm (table 1). View this table: Table 1 Number of patients with fibrosis stage F0–2, F3 and F4 according to LSM cut-offs recommended by the Baveno 6 consensus (10 and 15 kPa) and our previous paper (8 and 20, and 8 and 28 kPa) We also argue2 that patients with NITs above the rule-in cut-off for AF should undergo liver biopsy to identify those with cirrhosis who should undergo …

中文翻译：

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回复：NAFLD的无创检查和晚期慢性肝病：前进两步，后退一步？

我们感谢 Majumdar 和 Tsochatzis1 对我们的研究感兴趣，并欢迎有机会提供一些澄清。迄今为止的文献已经检查了非侵入性测试 (NIT) 算法来排除和排除晚期纤维化 (AF)。这种算法的主要用途是识别那些可以在初级保健中进行管理的 AF 风险低的人。我们提出了一种算法2，其中排除截止值针对 AF 保持优化，而规则截止值针对肝硬化进行了优化。我们提出的算法中 10% 的假阴性 (FN) 率是指 AF 而非肝硬化的 FN 率，如 Majumdar 和 Tsochatzis 在他们的信中所述。1 只有 18/570 (3%) 的肝硬化患者使用我们提出的算法（表 1）。查看此表： 表 1 F0-2 期纤维化患者数量，