5 kPa, but only fair in LSE medians ≥12.5 kPa: 94.3% versus 60.4%, respectively (P < 10−3). LSE thus demonstrated excellent negative predictive value for cirrhosis and very good positive predictive value for significant fibrosis. Conversely, it had insufficient positive

predictive value for cirrhosis and insufficient negative predictive value this website for significant fibrosis. Finally, the rate of well-classified patients by the LSE classification derived from Castera et al. cutoffs was not significantly different among its three classes, FFS0/1: 64.5%, FFS2/3: 60.4%, and FFS4: 60.4% (P = 0.379). In patients with LSE median <7.1 kPa, the diagnostic accuracy of the LSE classification derived from Castera et al. cutoffs was not significantly different among the three IQR/M subgroups (P = 0.458; Fig. 1). Conversely, in patients with LSE median ≥7.1 kPa the diagnostic accuracy of the LSE classification was significantly lower in LSE with IQR/M >0.30 compared to LSE with IQR/M ≤0.30 (43.8% versus 64.1%, P < 10−3; Fig. 1). The rates of well-classified patients for the binary diagnoses of significant fibrosis or cirrhosis as a function of IQR/M and LSE median are detailed in Supporting Fig. S1. Briefly, in patients with LSE median ≥7.1 kPa, LSE with IQR/M >0.30 had lower accuracy for significant fibrosis

than LSE with IQR/M ≤0.30 (67.6% versus 84.3%, P < 10−3). In patients with LSE median selleck compound ≥12.5 kPa, LSE with IQR/M >0.30 had lower accuracy for cirrhosis than LSE with IQR/M ≤0.30 (45.1% versus 64.0%, P = 0.011). The previous findings led us to develop new criteria for the interpretation of LSE results (Table 5). LSE accuracy in the 上海皓元医药股份有限公司 subgroup of LSE with IQR/M ≤0.10 was higher than in the whole population (Table 6). LSEs in this subgroup were thus considered

“very reliable.” LSE with 0.10< IQR/M ≤0.30 or with IQR/M >0.30 and LSE median <7.1 kPa provided accuracy similar to that of the whole population and were thus considered “reliable.” Finally, LSE with IQR/M >0.30 and LSE median ≥7.1 kPa provided accuracy lower than that of the whole population and were thus considered “poorly reliable. According to these new criteria, 16.6% of LSE were considered “very reliable,” 74.3% “reliable,” and 9.1% “poorly reliable.” Importantly, LSE AUROCs and diagnostic accuracies were significantly different among these three subgroups (Table 6). Finally, the rate of poorly reliable LSE according to the new criteria was significantly lower than that of unreliable LSE according to the usual definition (9.1% versus 24.3%, P < 10−3). We evaluated our new criteria for LSE reliability as a function of several potential influencing characteristics: cause of liver disease (CHC versus others), diagnostic indexes (AUROC, binary diagnosis of significant fibrosis or cirrhosis, LSE classification), and diagnostic cutoffs published by Ziol et al.,13 Stebbing et al.,14 and Friedrich-Rust et al.