{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T20:40:54Z","timestamp":1792528854359,"version":"4.5.0"},"reference-count":89,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non\u2010invasive tests are increasingly employed to evaluate liver fibrosis associated with metabolic dysfunction\u2013associated steatotic liver disease (MASLD). Accurate cutoffs for significant fibrosis (\u2265F2), advanced fibrosis (\u2265F3), and cirrhosis (F4) are critical for establishing diagnostic guidelines and qualification for MASLD\u2010related anti\u2010fibrotic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Determine optimal Enhanced Liver Fibrosis (ELF) Test MASLD cutoffs for \u2265F2, \u2265F3, and F4 identification and decision\u2010making, evaluate the appropriateness of guideline\u2010recommended cutoffs, and assess ELF performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using four databases, we identified 34 MASLD\u2010focused studies conducted between 2004 and 2026 evaluating ELF cutoffs (37 cohorts): quality was assessed using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS\u20102). Multiple cutoffs were integrated using hierarchical summary receiver operating characteristic analysis. Sensitivity (Sens) and specificity (Spec) at Youden cutoffs and guideline\u2010recommended cutoffs were estimated using Steinhauser's hierarchical multi\u2010cutoff random\u2010effects model and R\n                      <jats:italic>diagmeta<\/jats:italic>\n                      package v0.5\u20101.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Youden cutoffs (AUROCs [95% CIs]) were: \u2265F2: 9.37 (0.818 [0.781\u20130.850]); \u2265F3: 9.64 (0.818 [0.782\u20130.850]); F4: 9.99 (0.774 [0.711\u20130.827]). Sens and Spec at established cutoffs were: \u2265F2 (9.00) 0.86 Sens, 0.61 Spec; \u2265F3 (9.80) 0.70 Sens, 0.79 Spec; F4 (11.30) 0.21 Sens, 0.96; and F4 (10.50) 0.50 Sens, 0.86 Spec. For F2 rule\u2010out (7.70), Sens\u2009=\u20090.98 and Spec\u2009=\u20090.14.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ELF &lt;\u20099.00 may be useful to rule out \u2265 F2 fibrosis in MASLD. ELF \u2265\u20099.80 and \u2265\u200911.30 represent balanced cutoffs for \u2265F3 and F4 fibrosis, respectively. ELF \u2265\u200910.50 could represent an upper limit for MASLD\u2010related anti\u2010fibrotic therapeutic decision\u2010making. ELF at 7.70 is not a meaningful cutoff for any purpose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO registration: CRD420251145859<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70846","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T03:53:36Z","timestamp":1787630016000},"page":"864-889","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Meta\u2010Analysis: Enhanced Liver Fibrosis (\n                    <scp>ELF<\/scp>\n                    ) Test for Identifying Significant Fibrosis, Advanced Fibrosis, and Cirrhosis in Patients With Metabolic Dysfunction\u2010Associated Steatotic Liver Disease"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3931-0625","authenticated-orcid":false,"given":"Matthew F. 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