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We aimed to assess the performance of a sequential algorithm encompassing the Fibrosis 4 (FIB-4) and Enhanced Liver Fibrosis (ELF) scores for identifying patients at risk of advanced fibrosis. This cross-sectional study included one hospital-based cohort with biopsy-proven NAFLD (<jats:italic>n<\/jats:italic>\u2009=\u2009140) and two primary care cohorts from different clinical settings: Type 2 Diabetes (T2D) follow-up (<jats:italic>n<\/jats:italic>\u2009=\u2009141) and chronic liver disease (CLD) initial study (<jats:italic>n<\/jats:italic>\u2009=\u2009138). Logistic regression analysis was performed to assess liver fibrosis diagnosis models based on FIB-4 and ELF biomarkers. The sequential algorithm retrieved the following accuracy parameters in predicting stages F3\u20134 in the biopsy-confirmed cohort: sensitivity (85%), specificity (73%), negative predictive value (79%) and positive predictive value (81%). In both T2D and CLD cohorts, a total of 28% of patients were classified as stages F3\u20134. Furthermore, of all F3\u20134 classified patients in the T2D cohort, 80% had a diagnosis of liver disease and 44% were referred to secondary care. Likewise, of all F3\u20134 classified patients in the CLD cohort, 71% had a diagnosis of liver disease and 44% were referred to secondary care. These results suggest the potential utility of this algorithm as a liver fibrosis stratifying tool in primary care, where updating referral protocols to detect high-risk F3\u20134 is needed. FIB-4 and ELF sequential measurement is an efficient strategy to prioritize patients with high risk of F3\u20134 in populations with metabolic risk factors.<\/jats:p>","DOI":"10.1007\/s11739-023-03441-2","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T18:01:31Z","timestamp":1699725691000},"page":"745-756","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Accuracy of a sequential algorithm based on FIB-4 and ELF to identify high-risk advanced liver fibrosis at the primary care level"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3079-6364","authenticated-orcid":false,"given":"Pablo","family":"Gabriel-Medina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roser","family":"Ferrer-Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Ciudin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Augustin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Rivera-Esteban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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Peric\u00e0s: Consulting, speaking and travel fees (Boehringer-Ingelheim, MSD, Novo Nordisk, Gilead, Intercept, Rubi\u00f3, Pfizer, Astellas, CUBICIN, Novartis), Educational and research support (Madrigal, Novo Nordisk, Gilead, Pfizer, Astellas, Accelerate, Novartis, Abbvie, ViiV, and MSD. Funds from European Commission\/EFPIA IMI2 853966-2, IMI2 777377, H2020 847989, ISCIII PI19\/01898 and PI22\/01770). Salvador Augustin: Consulting \/ Advisory Boards (Boehringer Ingelheim, Gilead, Intercept, Novartis, Pfizer, Ferrer, IQVIA), Speaking fees (Allergan, Gilead, MSD, Menarini, Novartis, Allergan), Grants (Gilead). Rest of authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional (approved by the local Ethics Committee (PR(AG)601\/2020)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Vall d\u2019Hebron University Hospital (protocol code PR(AG)601\/2020 signed on 17 March 2021).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institutional review board statement"}},{"value":"Informed consent was obtained from all subjects involved in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}