5 kPa (Fig 1) LSE

with IQR/M >030 (ie, with large va

5 kPa (Fig. 1). LSE

with IQR/M >0.30 (i.e., with large variability) provided lower AUROCs and a lower rate of well-classified patients when compared to LSE with <0.10 IQR/M ≤0.30, but the difference was not statistically significant (Table anti-PD-1 antibody 4). Because multivariate analyses showed a significant interaction between these two variables, we evaluated the influence of IQR/M according to LSE median. The deleterious effect of IQR/M >0.30 on LSE accuracy was amplified by the liver stiffness level: the diagnostic accuracy for cirrhosis decreased even more in patients with LSE median ≥12.5 kPa, and accuracy for significant fibrosis significantly decreased in patients with LSE median ≥7.1 kPa. Finally, LSE with IQR/M >0.30 may be considered “poorly reliable” in patients with LSE median ≥7.1 kPa and “reliable” in patients with LSE median <7.1 kPa (Fig. 1). The interaction between IQR/M and liver stiffness level is not surprising: IQR corresponds to the interval around the LSE median containing 50% of the valid measurements between the 25th and 75th percentiles, and is usually expressed as the ratio IQR/M. A

high IQR/M implies a large distribution of LSE valid measurements and thus a higher risk of an aberrant LSE median. However, by definition, a high IQR/M also implies a smaller interval in low liver stiffness levels (compared to high stiffness levels). For example, an IQR/M at 0.30 represents a 1.5 kPa interval when liver stiffness is 5.0 kPa, but a 4.5 kPa interval when liver stiffness is 15.0 kPa. Consequently, IQR/M has little impact on LSE median in low liver stiffness levels, thus explaining Enzalutamide datasheet why LSE with IQR/M >0.30 may be considered “reliable” when LSE median is <7.1 kPa (Fig. 1). Because increasing liver stiffness amplifies the deleterious effect of IQR/M >0.30 with a significant decrease in diagnostic accuracy, LSE with IQR/M >0.30 and median ≥7.1 kPa may be considered “poorly reliable” (Table 6; Fig. 1). Finally, 上海皓元医药股份有限公司 by inverting the same reasoning, one can explain why

LSE with IQR/M ≤0.10 are very accurate in high liver stiffness values (Fig. 1). The intermediate category, LSE with 0.10< IQR/M ≤0.30, may be considered “reliable” (Table 4; Fig. 1). Finally, our results permitted the establishment of new reliability criteria identifying three LSE subgroups according to IQR/M and liver stiffness level (Table 5). The accuracy of LSE for fibrosis staging was significantly different between these three subgroups, thus demonstrating the relevance of these new criteria (Table 6). Moreover, the rate of poorly reliable LSE according to the new criteria (9.1%) was significantly lower than “unreliable” LSE as defined in the previous usual criteria (24.3%). In our study, as in those of Lucidarme et al. and Myers et al.,5, 6 the ≥10 valid measurements variable had no influence on LSE accuracy (Table 3). This leads to the question: How many valid measurements are required for LSE? Kettaneh et al.

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