Liver biopsy tissue, obtained under ultrasound guidance, was fixed, paraffin-embedded, and stained with at least hematoxylin and eosin and Masson’s trichrome. Two experienced hepatopathologists analyzed biopsy

specimens independently without knowledge of liver stiffness results or other clinical data. In cases of disagreement, a consensus was reached by joint discussion. In patients with NAFLD, fibrosis was staged according to the classification of Kleiner et al.18 (F0 = no fibrosis; F1 = perisinusoidal or portal fibrosis; F2 = perisinusoidal and portal/periportal fibrosis; F3 = septal or bridging fibrosis; and F4 = cirrhosis). In patients with all other liver conditions, including chronic viral hepatitis (with or without coexistent steatosis), fibrosis was staged according to the METAVIR classification (F0 = no fibrosis; F1 = portal fibrosis without septa; F2 = portal fibrosis with few septa; Everolimus molecular weight F3 = portal fibrosis with Palbociclib in vivo many septa; and F4 = cirrhosis). Steatosis was graded according to the NAFLD Activity Score (NAS: S0, <5% of hepatocytes affected; S1, 5%-33%; S2, 34%-66%; and S3, >66%).18 The severity of hepatic inflammation was graded according to the METAVIR classification in patients with viral hepatitis19 and the

lobular component of the NAS in those with NAFLD.18 Finally, the length of biopsy specimens and the number of portal tracts sampled were recorded as measures of biopsy quality. Biopsies less than 15 mm in length and/or with fewer than six portal triads were deemed uninterpretable. Patient characteristics and clinical data were descriptively summarized and are reported as medians (IQR) and proportions. Between-group comparisons were made using Fisher’s exact and chi-square tests for categorical variables, and Mann-Whitney and Wilcoxon matched 上海皓元 pairs sign-rank tests for continuous variables.

Correlations between variables, including liver stiffness measured using the M and XL probes, were described using Spearman correlation coefficients (ρ). Further analysis of the agreement between probes was assessed using Bland-Altman plots of the intraindividual differences in LSM with each probe versus the mean measurement.20 To identify independent predictors of reliable FibroScan examinations, multivariate logistic regression models including age, gender, liver disease etiology, BMI (categorized as <30, 30 to <35, 35 to <40, and ≥40 kg/m2), skin-capsular distance (categorized as <25 and ≥25 mm), diabetes mellitus, and moderate to severe hepatic steatosis were analyzed. Separate disease-specific models determined the influence of moderate to severe hepatic inflammation on FibroScan reliability. The diagnostic performances of the M and XL probes compared with liver histology as the reference standard were determined using areas under receiver operating characteristic (AUROC) curves.