The presence of diabetes impacts liver fibrosis and steatosis by transient elastography in a primary care population

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"documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2021;24C:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Mineralocorticoid receptor modulation by dietary sodium influences NAFLD development in mice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 2545 "Ancho" => 3167 "Tamanyo" => 491436 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Effect of MCD with high and low Na+ concentration on hepatic steatosis and activation of mineralocorticoid receptor signaling. A) There was no significant difference in increase of weight in mice fed with MCD, however, there is significantly less liver weight gain in the High-Na+/MCD. B) High-Na+/MCD showed less percentage of hepatic triglycerides content than Low-Na+/MCD. C) There were not significant differences in HOMA-IR calculated between the different MCD groups. D) There were no significant differences between different MCD groups in expression of fibrosis markers including monocyte chemoattractant protein-1, tissue inhibitor of metalloproteinases-1, alpha smooth muscle actin. E) There were not significant differences between different MCD groups in lipid genes activation such as ACC, SREBP1, SCD1. There is significantly less expression of FAS in High-Na+/MCD compared to Low-Na+/MCD. F) High-Na+/MCD activates mineralocorticoid receptor signaling significantly less than Low-Na+/MCD, with less serum aldosterone level, hepatic mineralocorticoid receptor (MR) activation and kidney MR activation. n = 10 mice per group, *p < 0.05, ** p < 0.01, ***p < 0.001 by ANOVA. G) Summary of the proposed mechanism. We propose that a high-Na+ intake leads to lower levels of MR expression, lower levels of aldosterone and less activation of RAAS. This down-modulation of the mineralocorticoid pathway allows for SIK1 overexpression. SIK-1 translocate to the nucleus where it downregulates the expression of lipogenic enzymes -such as FAS, ACC, SCD1-downstream of SREBP1, resulting in less lipogenesis, therefore less steatosis. Meanwhile, in the livers of animals with normal or low-Na+ intake, a HFD induces higher levels of aldosterone, activating the mineralocorticoid pathway, therefore, causing SIK-1 phosphorylation, phosphorylated SIK-1 accumulates in the cytoplasm and doesn’t take part in the regulation of hepatic lipogenic gene expression." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Cabrera, Isabel Rao, Fabiola Raasch, Nancy Solis, Margarita Pizarro, Mariela Freire, Diego Sáenz De Urturi, Carolina A. Ramírez, Nicolás Triantafilo, Jonathan León, Arnoldo Riquelme, Francisco Barrera, Rene Baudrand, Patricia Aspichueta, Marco Arrese, Juan P. 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"apellidos" => "Ramírez" ] 8 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Triantafilo" ] 9 => array:2 [ "nombre" => "Jonathan" "apellidos" => "León" ] 10 => array:2 [ "nombre" => "Arnoldo" "apellidos" => "Riquelme" ] 11 => array:2 [ "nombre" => "Francisco" "apellidos" => "Barrera" ] 12 => array:2 [ "nombre" => "Rene" "apellidos" => "Baudrand" ] 13 => array:2 [ "nombre" => "Patricia" "apellidos" => "Aspichueta" ] 14 => array:2 [ "nombre" => "Marco" "apellidos" => "Arrese" ] 15 => array:2 [ "nombre" => "Juan P." "apellidos" => "Arab" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268121000569?idApp=UINPBA00004N" "url" => "/16652681/000000240000000C/v7_202205201403/S1665268121000569/v7_202205201403/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268121000375" "issn" => "16652681" "doi" => "10.1016/j.aohep.2021.100338" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "100338" "copyright" => "Fundación Clínica Médica Sur, A.C." 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Chávez-Tapia, Francisco Sanchez-Giron, Eira Cerda-Reyes, Victor Hugo Rosales-Salyano, Alfredo Servin-Caamaño, Martín Uriel Vázquez-Medina, Nahum Méndez-Sánchez" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Paulina" "apellidos" => "Vidal-Cevallos" ] 1 => array:2 [ "nombre" => "Fatima" "apellidos" => "Higuera-De-La-Tijera" ] 2 => array:2 [ "nombre" => "Norberto C." 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Trivedi, Michael P. Curry, Michelle Lai" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Hirsh D." "apellidos" => "Trivedi" ] 1 => array:2 [ "nombre" => "Michael P." "apellidos" => "Curry" ] 2 => array:2 [ "nombre" => "Michelle" "apellidos" => "Lai" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268121000466?idApp=UINPBA00004N" "url" => "/16652681/000000250000000C/v5_202112240929/S1665268121000466/v5_202112240929/en/main.assets" ] ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "The presence of diabetes impacts liver fibrosis and steatosis by transient elastography in a primary care population" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hirsh D. Trivedi, Jaspreet Suri, Daheun Oh, Jeffrey Schwartz, Daniela Goyes, Rajab Idriss, Michael P. Curry, Michelle Lai" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Hirsh D." "apellidos" => "Trivedi" "email" => array:1 [ 0 => "htrived1@bidmc.harvard.edu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jaspreet" "apellidos" => "Suri" "email" => array:1 [ 0 => "Jaspreet.Suri@nuvancehealth.org" ] ] 2 => array:3 [ "nombre" => "Daheun" "apellidos" => "Oh" "email" => array:1 [ 0 => "daheunoh@gmail.com" ] ] 3 => array:3 [ "nombre" => "Jeffrey" "apellidos" => "Schwartz" "email" => array:1 [ 0 => "jaschwar@bidmc.harvard.edu" ] ] 4 => array:3 [ "nombre" => "Daniela" "apellidos" => "Goyes" "email" => array:1 [ 0 => "danigoyes93@gmail.com" ] ] 5 => array:3 [ "nombre" => "Rajab" "apellidos" => "Idriss" "email" => array:1 [ 0 => "ridriss@health.southalabama.edu" ] ] 6 => array:3 [ "nombre" => "Michael P." "apellidos" => "Curry" "email" => array:1 [ 0 => "mcurry@bidmc.harvard.edu" ] ] 7 => array:3 [ "nombre" => "Michelle" "apellidos" => "Lai" "email" => array:1 [ 0 => "mlai@bidmc.harvard.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2053 "Ancho" => 1250 "Tamanyo" => 126054 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A proposed referral pathway based on noninvasive assessment in patients with type 2 diabetes mellitus in a primary care population. *Surveillance includes consideration for esophageal variceal and hepatocellular carcinoma screening protocols." ] ] ] "textoCompleto" => "1IntroductionThe incidence of nonalcoholic fatty liver disease (NAFLD) in the community is increasing, along with the growth of obesity, type 2 diabetes mellitus (T2DM) and other metabolic risk factors. NAFLD is projected to be the leading cause of liver transplantation and contributes to significant morbidity and mortality worldwide [<a class="elsevierStyleCrossRefs" href="#bib0005">1–5</a>]. The presence of T2DM, in particular, portends an increased risk of NAFLD, nonalcoholic steatosis (NASH), advanced liver fibrosis and its related complications. While screening for NAFLD in the general population is controversial, there is growing consensus by international guidelines that patients with T2DM should be screened [<a class="elsevierStyleCrossRefs" href="#bib0030">6–8</a>], as they are at heightened risk for the more severe form of NAFLD and its complications [<a class="elsevierStyleCrossRef" href="#bib0045">9</a>,<a class="elsevierStyleCrossRef" href="#bib0050">10</a>].Type 2 diabetes is a known risk factor for NAFLD, NASH and advanced fibrosis. In a large meta-analysis from 22 countries, the pooled prevalence of T2DM in NAFLD and NASH patients was 23% and 44%, respectively, estimates that are larger than the general population [<a class="elsevierStyleCrossRef" href="#bib0005">1</a>]. T2DM is an independent predictor of advanced liver fibrosis [<a class="elsevierStyleCrossRef" href="#bib0055">11</a>,<a class="elsevierStyleCrossRef" href="#bib0060">12</a>]. In a European NAFLD registry, the presence of T2DM predicted advanced fibrosis with an odds ratio (OR) of 4.68 (95% confidence interval [CI]: 2.17–10.10, P < 0.001). Additionally, a study with serial liver biopsies showed the stage of fibrosis on index biopsy to be associated with T2DM (P < 0.001) [<a class="elsevierStyleCrossRef" href="#bib0065">13</a>]. In fact, 80% of patients who had fibrosis progression were diabetic, compared to only 25% of those who did not have fibrosis progression (P = 0.005). Another biopsy-proven NAFLD cohort demonstrated increased liver-related (adjusted hazard ratio [aHR]: 2.19, 95% CI: 1–4.81) and overall mortality (aHR: 2.09, 95% CI: 1.39–3.14) in those with diabetes [<a class="elsevierStyleCrossRef" href="#bib0070">14</a>]. Hence, targeting T2DM in the community where the burden of NAFLD is high, and where general practitioners serve as the frontline, is critical.NAFLD, NASH and related fibrosis are the rule rather than the exception in patients with T2DM. Reports estimate the presence of NAFLD and advanced fibrosis in outpatient T2DM cohorts to be significant [<a class="elsevierStyleCrossRef" href="#bib0075">15</a>,<a class="elsevierStyleCrossRef" href="#bib0080">16</a>]. Given the high prevalence of T2DM in the community, the screening of NAFLD would ideally take place in the primary care setting. In fact, the American Diabetes Association (ADA) guideline recommends evaluating for NAFLD at the time of diagnosis of T2DM or prediabetes and annually thereafter, and for patients who have abnormal liver enzymes or steatosis on imaging, they recommend evaluating for nonalcoholic steatohepatitis (NASH) and liver fibrosis, along with a referral to a specialist [<a class="elsevierStyleCrossRef" href="#bib0030">6</a>]. Other international guidelines, including AASLD and EASL, recommend noninvasive assessment of fibrosis in patients who are deemed high risk for NAFLD, including those with T2DM [<a class="elsevierStyleCrossRef" href="#bib0035">7</a>,<a class="elsevierStyleCrossRef" href="#bib0040">8</a>].Fibrosis assessment in patients with NAFLD is crucial to prognosticate liver-related risk, as those with advanced fibrosis and cirrhosis can develop HCC and portal hypertension, increasing morbidity and mortality. Liver biopsy remains the gold standard for the diagnosis of NAFLD and fibrosis, but it is costly and involves risk [<a class="elsevierStyleCrossRef" href="#bib0085">17</a>]. However, several reliable noninvasive methods of fibrosis assessment have reduced the need for liver biopsy and provide a simple strategy for general practitioners to evaluate liver fibrosis. The advent of transient elastography (TE) has revolutionized the evaluation of liver fibrosis [<a class="elsevierStyleCrossRef" href="#bib0090">18</a>]. In fact, TE scores accurately predict liver-related outcomes including advanced fibrosis, cirrhosis, portal hypertension and its sequelae [<a class="elsevierStyleCrossRefs" href="#bib0095">19–21</a>]. At the moment, TE is ordered and managed only by specialty hepatologists. However, improving accessibility of TE to general practitioners can facilitate early detection of high-risk NAFLD in the community and institute timely referral and treatment [<a class="elsevierStyleCrossRef" href="#bib0110">22</a>,<a class="elsevierStyleCrossRef" href="#bib0115">23</a>].The need for a simple diagnostic pathway for general practitioners to assess liver fibrosis in high-risk patients (i.e. T2DM) is imperative. Abnormal liver enzymes are historically unreliable [<a class="elsevierStyleCrossRef" href="#bib0060">12</a>,<a class="elsevierStyleCrossRefs" href="#bib0120">24–26</a>], but remain the primary tool used to dictate specialist referral. This leads to unnecessary referrals with specialists seeing patient’s with mild disease and advanced disease going unnoticed in the community. Noninvasive measures, however, can reliably replace or be used in conjunction with liver enzyme tests. Several studies in the United Kingdom (UK) demonstrate that the targeted use of noninvasive testing pathways in the community helps risk-stratify patient’s liver disease by fibrosis level, reduces unnecessary specialist referrals, and is cost-effective [<a class="elsevierStyleCrossRefs" href="#bib0135">27–29</a>]. Improving accessibility of TE to general practitioners through a network referral system can help triage mild disease from more severe NAFLD that would warrant hepatology referral. We created an open access TE referral program for patients from the community within our hospital network. In this study, we evaluated the association of T2DM in our primary care referral network with TE findings using this primary care based open access database.2Materials and methods2.1Study populationThis is a retrospective cohort study of patients from an open access TE program created at Beth Israel Deaconess Medical Center (BIDMC) starting August 2017. Primary care physicians (PCPs) within BIDMC and its network ordered liver stiffness measurement by TE. PCPs were educated on the appropriate indications for TE referral through a series of expert lectures, emails and handouts. The referral indications included patients who were deemed high-risk for NAFLD with features of T2DM, obesity, metabolic syndrome, or a family history of cryptogenic cirrhosis. Other indications included abnormal liver enzymes, steatosis or other abnormalities on liver imaging. We collected data from 510 patients who had a TE from August 2017 to August 2019. Patients were identified as having T2DM based on their problem list or presence of oral hypoglycemic or insulin in their medication list. We excluded patients with a history of viral hepatitis, alcohol-related liver disease or alcohol abuse, which was defined as an excess of 14 beverages per week for males and 7 beverages per week for females (N = 73 patients) leaving us with a total sample size of 437 patients. The remaining cohort of patients did not have other liver diseases, biliary obstruction or hepatic malignancies, as those patients were referred to the appropriate specialist (i.e. hepatology) and not included into this PCP-based TE referral pathway.2.2Vibration-controlled transient elastographyAll patients in this study received liver stiffness measurement by TE (FibroScan, Echosens, Paris, France). It was ensured that all included TE exams fulfilled the following criteria: fasting state, >10 valid measurements, and an interquartile range-to-median ratio (IQR/median) <30%. All measurements were started using the M probe, and transitioned to the XL probe only if the initial measurement was inappropriate. All patients also had controlled-attenuation parameter (CAP) measured during the TE exam to evaluate for steatosis. A CAP score cut-off of ≥ 248 dB/m was used to identify steatosis, while a CAP score ≥ 280 dB/m suggested severe steatosis. A trained medical assistant performed the TE. The findings were then evaluated by a hepatologist, who provided referral recommendations to the primary care physician.2.3CovariatesInformation on patient demographics and referral patterns was collected, in addition to multiple clinical characteristics related to the patient’s liver disease and TE score findings. This includes social history, anthropometric measures, laboratory values, and imaging findings. Patient comorbidities, including the presence of coronary artery disease, hyperlipidemia, and obstructive sleep apnea, were recorded after evaluating their problem list. Data on heart failure or drugs causing steatosis were not collected.2.4Statistical analysisThe primary aim of this study was to evaluate the association of T2DM with TE score to inform whether patients with T2DM in our primary care referral population should be targeted for selective TE referral pathways. The primary outcome of TE score was evaluated both as a continuous variable, as well as binary categorical variables with different cut-offs of 7 and 10 kPa. A two-sided Student T-test was used to evaluate the association between the T2DM and continuous TE score given a normal distribution, while a Pearson chi-square test was used to evaluate T2DM with the binary TE scores. A secondary aim of the study was to evaluate the association of T2DM with the CAP score, which was measured as a continuous variable and as separate dichotomous variables with cut-offs of 248 dB/m for steatosis and 280 dB/m for severe steatosis. Two-sided T-test and Pearson chi-square test were used to evaluate continuous and categorical CAP scores, respectively, in the two samples. Continuous variables were expressed as means with standard deviations. Categorical variables were expressed as proportions with percentages (%) and odds ratios (OR) with 95% confidence intervals (CI). Stepwise multivariate linear and logistic regression was used to identify predictors of the outcomes and control for confounding. Independent predictors were added to the multivariate model for the adjusted analysis. A P-value below the set alpha level of 0.05 was considered statistically significant. Stata/IC 15.1 software was used for all statistical analysis.3Results3.1Baseline demographics<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> demonstrates the baseline characteristics of the study population. There were a total of 124 patients with diabetes and 313 patients without diabetes. Diabetic patients were older (58 ± 11 vs 52 ± 13), more likely to be female (53% vs 41%) and had a higher hemoglobin A1c (HbA1c) level (7.3 ± 1.4 vs 5.9 ± 3.3) compared to those without diabetes. The predominant ethnicity in both groups was Caucasian consisting of 56% and 65% in the diabetic and non-diabetic groups, respectively. Body mass index (BMI), smoking status, alanine aminotransferase (ALT) and platelet levels were not different between the two groups. However, the FIB-4 index score was significantly higher in those with diabetes compared to their counterparts (1.56 ± 1.03 vs 1.25 ± 0.87). This difference persisted when FIB-4 score was dichotomized into a binary score with a cut-off of 1.45 (P = 0.008). Additionally, those with diabetes had a higher percentage of coronary artery disease (13% vs. 2%), hyperlipidemia (75% vs 35%), and obstructive sleep apnea (31% vs. 11%).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>3.2Transient elastography scoreThe presence of T2DM was significantly associated with the TE score. First and foremost, when kept as a continuous measure, patients with T2DM had a significantly higher TE score compared to those without diabetes (8.3 kPa ± 6 vs 6.4 kPa ± 3.7, P-value = 0.0001). An unadjusted analysis demonstrated a beta-coefficient of 1.83 (95% CI: 0.89–2.77, P < 0.001) as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Once adjusted for independent predictors, including age, BMI, ALT, HbA1c, and steatosis on imaging, the difference remained statistically significant (beta-coefficient: 1.90, 95% CI: 0.74–3.06, P-value = 0.001). The TE score was then categorized into two separate cut-offs as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. When using a lower cut-off, the unadjusted OR for diabetics having a TE score ≥7 kPa was 2.42 (95% CI: 1.55–3.77, P < 0.001). After multivariate adjustment, the OR increased to 2.65 (95% CI: 1.50–4.69, P = 0.001). When using a higher TE score cut-off of 10 kPa, the unadjusted and adjusted OR were 2.35 (95% CI: 1.31–4.23, P = 0.004) and 2.08 (95% CI: 1–4.32, P = 0.049), respectively.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>3.3Controlled attenuation parameterThe presence of T2DM was also associated with CAP score, an important measure of steatosis (<a class="elsevierStyleCrossRefs" href="#tbl0010">Table 2 and 3</a>). The mean CAP score was significantly higher in those with T2DM compared to those without T2DM (322 ± 51 vs 296 ± 57, P < 0.0001). In an unadjusted analysis, the beta-coefficient was 26 (95% CI: 14.3–37.73, P < 0.001), and remained statistically significant after multivariate adjustment for age, BMI, ALT and HbA1c levels (beta-coefficient: 22.8, 95% CI: 9.33–36.2, P = 0.001). CAP score was then evaluated at two separate cut-offs with a score of ≥248 dB/m and ≥280 dB/m signifying the presence of steatosis and severe steatosis, respectively. When using the lower cut-off for steatosis, the unadjusted odds ratio was 3.23 (95% CI: 1.49–7, P-value = 0.003). After adjusting for independent predictors, the OR was 2.18 (95% CI: 0.87–5.41, P = 0.09). When using the higher cut-off for severe steatosis, the unadjusted (OR: 3.27, 95% CI: 1.9–5.63, P < 0.001) and adjusted estimates (OR: 2.33, 95% CI: 1.18–4.60, P = 0.015) remained significant.4DiscussionThe presence of T2DM impacts liver-related outcomes. Patients with T2DM are more likely to have NAFLD, advanced fibrosis, and have an increased risk of mortality compared to those without diabetes [<a class="elsevierStyleCrossRef" href="#bib0005">1</a>,<a class="elsevierStyleCrossRefs" href="#bib0055">11–14</a>]. Screening for NAFLD remains controversial. However, there is growing consensus from international societies including ADA, AASLD, and EASL, to noninvasively screen diabetics for liver fibrosis regardless of pre-existing NAFLD [<a class="elsevierStyleCrossRefs" href="#bib0030">6–8</a>]. As seen in UK cohorts, noninvasive screening pathways can facilitate appropriate referral, reduce healthcare costs, and also implement early intervention [<a class="elsevierStyleCrossRefs" href="#bib0135">27–29</a>]. The reproducibility of such results in United States (US) based cohorts is warranted, as treatments such as weight loss from lifestyle intervention or bariatric surgery, as well as certain pharmacologic therapies on the horizon, can alter the course of the disease if instituted early on [<a class="elsevierStyleCrossRef" href="#bib0110">22</a>,<a class="elsevierStyleCrossRef" href="#bib0150">30</a>,<a class="elsevierStyleCrossRef" href="#bib0155">31</a>]. As the burden of NAFLD continues to grow worldwide, screening patients with T2DM is crucial. However, the optimal method of noninvasive screening in the primary care population is not known.TE is a validated tool increasingly used in clinical practice to prognosticate patients with liver disease, but its accessibility to general practitioners is limited. Improving its access to physicians treating patients at risk for NAFLD, such as those with T2DM, is imperative to prevent under diagnosis and inappropriate referral that places burden on the healthcare system. Improving access of TE to general practitioners, who serve on the frontline, can aid in the detection of NAFLD and advanced fibrosis. In this study, general practitioners had direct access to obtaining TE for their patients who were deemed to have high-risk of liver disease. We evaluate the association of liver fibrosis and steatosis by TE with the presence of T2DM in this primary care referral population.TE scores accurately predict fibrosis and liver-related outcomes. However, studies on its use in patients at-risk of NAFLD within US-based primary care populations are limited. In our study, we demonstrate significantly higher TE and CAP scores in patients with T2DM in our primary care population compared to those without diabetes. The statistical difference persists when categorizing the TE and CAP scores into distinct, clinically relevant cut-offs. The findings demonstrate that diabetics are at 2.7 times the odds of having moderate-to-severe fibrosis (≥7 kPa, P = 0.001) and at 2.1 times the odds of having advanced fibrosis or cirrhosis (≥10 kPa, P = 0.049). Using CAP score, diabetics also demonstrated increased odds of having any steatosis (≥248 dB/M, OR: 2.18, P = NS) or severe steatosis (≥ 280 dB/m, OR: 2.33, P = 0.015). Not surprisingly, as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, the proportion of diabetics progressively increases as the fibrosis level worsens based on TE score and FIB-4, an alternate noninvasive measure of fibrosis. Interestingly, the ALT level in both groups were similar, despite those with T2DM having increased amounts of steatosis and fibrosis. These results exhibit similar trends seen in previous reports and can help guide general practitioners to determine further surveillance, treatment and referral strategies.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Access to TE is limited only to specialty hepatologists at the moment. However, our study justifies the need for enhanced access of TE to general practitioners in order to prognosticate liver-related risk by improving detection of steatosis, advanced liver fibrosis and cirrhosis in those with T2DM. We show an increased risk of steatosis and advanced fibrosis by TE in patients with T2DM even without having a previous diagnosis of NAFLD, justifying screening for all diabetics [<a class="elsevierStyleCrossRef" href="#bib0030">6</a>]. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> illustrates a proposed pathway that general practitioners could use to determine the need for specialist referral based on TE score, without having to rely on misleading liver enzyme tests or costly imaging techniques. Enhanced TE access can potentially mitigate the under diagnosis of NAFLD in the community while also reducing unnecessary referrals to specialists and improving healthcare resource utilization.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>There are additional strengths and limitations in our study. First off, our reports of fibrosis and steatosis are consistent with previous studies in T2DM patients confirming its significant presence within primary care populations [<a class="elsevierStyleCrossRef" href="#bib0075">15</a>,<a class="elsevierStyleCrossRef" href="#bib0080">16</a>]. The strong association of TE findings with the presence of T2DM has strong management implications that can potentially change clinical practice. The generalizability of our results to other US-based primary care cohort populations serves as an additional strength of our study. However, although we did account for independent predictors to minimize confounding, the observational and retrospective nature of the study makes it prone to unmeasured confounders that may ultimately influence the results. Additionally, the possibility of referral bias in our cohort indicates the need to replicate these results in a generalized primary care cohort with a simple and accessible method of fibrosis measurement, which remains to be validated. Lastly, a propensity score matched study design would enhance the results of this study but requires a significantly larger sample size. Hence, longitudinal prospective studies validating these results and evaluating this algorithm within primary care clinics in the US are warranted.AbbreviationsNAFLDnon-alcoholic liver diseaseT2DMtype 2 diabetes mellitusNASHnon-alcoholic steatohepatitisORodds ratioCIconfidence intervalHRhazards ratioADAAmerican Diabetes AssociationAASLDAmerican Association for the Study of Liver DiseaseEASLEuropean Association for the Study of the LiverHCChepatocellular carcinomaTEtransient elastographyUKUnited KingdomBIDMCBeth Israel Deaconess Medical CenterPCPprimary care physiciansCAPcontrolled-attenuation parameterkPakilopascalsHbA1chemoglobin A1cBMIbody-mass indexALTalanine aminotransferaseFIB-4fibrosis-4 indexNSnot significant" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1714367" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1515711" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Vibration-controlled transient elastography" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Covariates" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 4 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Baseline demographics" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Transient elastography score" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Controlled attenuation parameter" ] ] ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "xack604527" "titulo" => "Acknowledgments" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-01-18" "fechaAceptado" => "2021-02-18" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1515711" "palabras" => array:4 [ 0 => "Non-alcoholic fatty liver disease" 1 => "Liver fibrosis" 2 => "Steatosis" 3 => "Metabolic syndrome" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectivesNoninvasive liver assessment in type 2 diabetes (T2DM) in a primary care population identifies higher risk non-alcoholic fatty liver disease (NAFLD). We aimed to evaluate the association of T2DM with liver fibrosis and steatosis by transient elastography (TE). Materials and MethodsThis is a retrospective study of a TE referral program where primary care physicians were able to order TE. Patients with alcohol abuse were excluded. TE and Controlled Attenuation Parameter (CAP) scores were obtained. Multivariable linear and logistic regression models were used to adjust for confounders. Results28% had T2DM. The mean TE score in T2DM patients was 8.3 (±6) kilopascal (kPa) and 6.4 (±3.7) kPa in those without T2DM (p = 0.0001). Those with T2DM had a higher CAP (322 ± 51 dB/m vs. 296 ± 57 dB/m, p < 0.0001). In multivariable analysis, T2DM was associated with TE score (β: 1.9, 95% confidence interval [CI]: 0.74–3.1, p = 0.001) and CAP (β: 2.8, 95% CI: 9.3–36.2, p = 0.001). Patients with T2DM had higher-risk TE scores and more steatosis by CAP. ConclusionT2DM is associated with liver fibrosis and steatosis by TE within a primary care population. A TE referral pathway may be utilized for T2DM patients who are at higher risk of NAFLD and its complications." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1874 "Ancho" => 1583 "Tamanyo" => 152476 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "a: This figure illustrates the proportion of type 2 diabetes patients within individual transient elastography risk categories. b: This figure illustrates the percentage of type 2 diabetics within FIB-4 risk categories (N = 338)." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2053 "Ancho" => 1250 "Tamanyo" => 126054 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A proposed referral pathway based on noninvasive assessment in patients with type 2 diabetes mellitus in a primary care population. *Surveillance includes consideration for esophageal variceal and hepatocellular carcinoma screening protocols." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: body mass index, ALT: alanine aminotransferase, HbA1c: hemoglobin A1c, CAP: controlled attenuation parameter, TE: transient elastography." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes (N = 124) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No Diabetes (N = 313) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.4 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.4 (13.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female (%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (53.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (41.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ethnicity</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caucasian</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">197 (64.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 (54.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hispanic</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (16.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (13.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">African American</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (16.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asian</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (10.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.5 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.4 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking (%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Never</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">192 (68.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (56.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.056</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Former</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (23.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (34.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALT Level (IU/L)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.9 (30.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.7 (39.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelet Level (K/uL)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">244.1 (67.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">246.4 (71.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HbA1c (%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FIB-4 Score (points)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.56 (1.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.25 (0.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" colspan="2">FIB-4 Stage</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low (<1.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">169 (72.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (58.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indeterminate-or-high (≥ 1.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 (27.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (41.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Steatosis on Imaging</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 (86.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142 (76.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coronary Artery Disease</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (12.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperlipidemia</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 (75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">109 (34.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obstructive Sleep Apnea</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (30.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAP Score (dB/m)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">322.1 (51.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">296.1 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Steatosis by CAP(≥248 dB/m)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 (93.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">245 (81.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe Steatosis by CAP(≥280 dB/m)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">102 (84.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">187 (62.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TE Score (kPa)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.4 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" colspan="2">TE Score Category</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 7 kPa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">241 (77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 (58.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥ 7 kPa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (41.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 10 kPa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">284 (90.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (80.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥ 10 kPa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (19.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" colspan="2">TE Probe</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M probe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">214 (68.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (53.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XL probe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 (31.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 (46.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2911063.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline Characteristics of Study Population." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Independent predictors that were adjusted for in the multivariate linear regression model were age, BMI, ALT level, HbA1c. Steatosis on imaging was kept in the TE outcome model, but not used for CAP score.CI: confidence interval, TE: transient elastography, CAP: controlled attenuation parameter." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Unadjusted Estimate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted Estimate</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Continuous Outcome \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">β-coefficient (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">β-coefficient(95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TE Score (kPa) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.83(0.89–2.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.90(0.74–3.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAP Score (dB/m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.02(14.3–37.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.76(9.33–36.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2911064.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Transient Elastography Findings as Continuous Measures." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Independent predictors that were adjusted for in the multivariate linear regression model were age, BMI, ALT level, HbA1c. Steatosis on imaging was kept in the TE outcome model, but not used for CAP score.CI: confidence interval, TE: transient elastography, CAP: controlled attenuation parameter." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" colspan="2" style="border-bottom: 2px solid black">Categorical Outcome</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unadjusted Estimate</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted Estimate</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds Ratio (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds Ratio(95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TE Score Category(kPa)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.42(1.55–3.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.65(1.50–4.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.35(1.31–4.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.08(1.00–4.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.049 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAP Score (dB/m)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Steatosis (≥248 dB/m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.23(1.49–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.18(0.87–5.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe Steatosis(≥280 dB/m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.27(1.90–5.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.33(1.18–4.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2911062.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Transient Elastography Findings as Categorical Measures." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Z.M. Younossi" 1 => "A.B. Koenig" 2 => "D. Abdelatif" 3 => "Y. Fazel" 4 => "L. Henry" 5 => "M. Wymer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.28431" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2016" "volumen" => "64" "numero" => "1" "paginaInicial" => "73" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26707365" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z.M. Younossi" 1 => "D. Blissett" 2 => "R. Blissett" 3 => "L. Henry" 4 => "M. Stepanova" 5 => "Y. Younossi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.28785" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2016" "volumen" => "64" "numero" => "5" "paginaInicial" => "1577" "paginaFinal" => "1586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27543837" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "V.W. Setiawan" 1 => "D.O. Stram" 2 => "J. Porcel" 3 => "S.C. Lu" 4 => "L. Le Marchand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.28677" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2016" "volumen" => "64" "numero" => "6" "paginaInicial" => "1969" "paginaFinal" => "1977" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27301913" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Noureddin" 1 => "A. Vipani" 2 => "C. Bresee" 3 => "T. Todo" 4 => "I.K. Kim" 5 => "N. Alkhouri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2018" "volumen" => "113" "numero" => "11" "paginaInicial" => "1649" "paginaFinal" => "1659" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of non-alcoholic fatty liver disease in primary care: a population health perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Dokmak" 1 => "B. Lizaola-Mayo" 2 => "H.D. Trivedi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9343(82)90059-6" "Revista" => array:3 [ "tituloSerie" => "Am J Med" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7102710" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving care and promoting health in populations: standards of medical care in Diabetes-2020" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Association AD" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc20-S001" "Revista" => array:7 [ "tituloSerie" => "Diabetes Care" "fecha" => "2020" "volumen" => "43" "numero" => "Suppl 1" "paginaInicial" => "S7" "paginaFinal" => "s13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31862744" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Chalasani" 1 => "Z. Younossi" 2 => "J.E. Lavine" 3 => "M. Charlton" 4 => "K. Cusi" 5 => "M. Rinella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.29367" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2018" "volumen" => "67" "numero" => "1" "paginaInicial" => "328" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28714183" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "[8]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2015.11.004" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2016" "volumen" => "64" "numero" => "6" "paginaInicial" => "1388" "paginaFinal" => "1402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27062661" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "[9]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Angulo" 1 => "J.C. Keach" 2 => "K.P. Batts" 3 => "K.D. Lindor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.510300604" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "1999" "volumen" => "30" "numero" => "6" "paginaInicial" => "1356" "paginaFinal" => "1362" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10573511" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "[10]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes is associated with increased risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Yang" 1 => "F. Ahmed" 2 => "K.C. Mara" 3 => "B.D. Addissie" 4 => "A.M. Allen" 5 => "G.J. Gores" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.510240222" "Revista" => array:3 [ "tituloSerie" => "Hepatology" "fecha" => "2019" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8690415" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "[11]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of advanced fibrosis in non-cirrhotic non-alcoholic fatty liver disease in Germany" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Labenz" 1 => "Y. Huber" 2 => "E. Kalliga" 3 => "M. Nagel" 4 => "C. Ruckes" 5 => "B.K. Straub" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apt.14976" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2018" "volumen" => "48" "numero" => "10" "paginaInicial" => "1109" "paginaFinal" => "1116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30288767" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "[12]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Mofrad" 1 => "M.J. Contos" 2 => "M. Haque" 3 => "C. Sargeant" 4 => "R.A. Fisher" 5 => "V.A. Luketic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2003.50229" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2003" "volumen" => "37" "numero" => "6" "paginaInicial" => "1286" "paginaFinal" => "1292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12774006" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "[13]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. McPherson" 1 => "T. Hardy" 2 => "E. Henderson" 3 => "A.D. Burt" 4 => "C.P. Day" 5 => "Q.M. Anstee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2014.11.034" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2015" "volumen" => "62" "numero" => "5" "paginaInicial" => "1148" "paginaFinal" => "1155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25477264" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "[14]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of all-cause mortality and liver-related mortality in patients with non-alcoholic fatty liver disease (NAFLD)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Stepanova" 1 => "N. Rafiq" 2 => "H. Makhlouf" 3 => "R. Agrawal" 4 => "I. Kaur" 5 => "Z. Younoszai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-013-2743-5" "Revista" => array:7 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2013" "volumen" => "58" "numero" => "10" "paginaInicial" => "3017" "paginaFinal" => "3023" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23775317" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "[15]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Kwok" 1 => "K.C. Choi" 2 => "G.L. Wong" 3 => "Y. Zhang" 4 => "H.L. Chan" 5 => "A.O. Luk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gutjnl-2015-309265" "Revista" => array:7 [ "tituloSerie" => "Gut" "fecha" => "2016" "volumen" => "65" "numero" => "8" "paginaInicial" => "1359" "paginaFinal" => "1368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25873639" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "[16]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Doycheva" 1 => "J. Cui" 2 => "P. Nguyen" 3 => "E.A. Costa" 4 => "J. Hooker" 5 => "H. Hofflich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apt.13405" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2016" "volumen" => "43" "numero" => "1" "paginaInicial" => "83" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26369383" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "[17]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of liver imaging and biopsy in clinical practice. N Engl J Med. 377. United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.B. Tapper" 1 => "A.S.F. Lok" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "paginaInicial" => "2296" "paginaFinal" => "2297" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "[18]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effective evaluation of nonalcoholic fatty liver disease with NAFLD fibrosis score and vibration controlled transient elastography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.B. Tapper" 1 => "N. Sengupta" 2 => "M.G. Hunink" 3 => "N.H. Afdhal" 4 => "M. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2015.241" "Revista" => array:7 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2015" "volumen" => "110" "numero" => "9" "paginaInicial" => "1298" "paginaFinal" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26303130" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "[19]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Bureau" 1 => "S. Metivier" 2 => "J.M. Peron" 3 => "J. Selves" 4 => "M.A. Robic" 5 => "P.A. Gourraud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2008.03701.x" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2008" "volumen" => "27" "numero" => "12" "paginaInicial" => "1261" "paginaFinal" => "1268" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18397389" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "[20]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "M. Lemoine" 1 => "S. Katsahian" 2 => "M. Ziol" 3 => "P. Nahon" 4 => "N. Ganne-Carrie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2008.03825.x" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2008" "volumen" => "28" "numero" => "9" "paginaInicial" => "1102" "paginaFinal" => "1110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18691352" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "[21]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive assessment of fibrosis regression in hepatitis C virus sustained virologic responders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.D. Trivedi" 1 => "S.C. Lin" 2 => "D.T. Lau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Hepatol (N Y)" "fecha" => "2017" "volumen" => "13" "numero" => "10" "paginaInicial" => "587" "paginaFinal" => "595" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "[22]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonalcoholic fatty liver disease: what does the primary care physician need to know?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Budd" 1 => "K. Cusi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9343(82)90059-6" "Revista" => array:3 [ "tituloSerie" => "Am J Med" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7102710" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "[23]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Williams" 1 => "R. Aspinall" 2 => "M. Bellis" 3 => "G. Camps-Walsh" 4 => "M. Cramp" 5 => "A. Dhawan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)61838-9" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "384" "numero" => "9958" "paginaInicial" => "1953" "paginaFinal" => "1997" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25433429" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "[24]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health outcomes following liver function testing in primary care: a retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. McLernon" 1 => "P.T. Donnan" 2 => "S. Ryder" 3 => "P. Roderick" 4 => "F.M. Sullivan" 5 => "W. Rosenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/fampra/cmp025" "Revista" => array:7 [ "tituloSerie" => "Fam Pract" "fecha" => "2009" "volumen" => "26" "numero" => "4" "paginaInicial" => "251" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19439435" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "[25]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.L. Fracanzani" 1 => "L. Valenti" 2 => "E. Bugianesi" 3 => "M. Andreoletti" 4 => "A. Colli" 5 => "E. Vanni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22429" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "volumen" => "48" "numero" => "3" "paginaInicial" => "792" "paginaFinal" => "798" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18752331" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "[26]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic and histological features of non-alcoholic fatty liver disease patients with different serum alanine aminotransferase levels" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.W. Wong" 1 => "G.L. Wong" 2 => "S.W. Tsang" 3 => "A.Y. Hui" 4 => "A.W. Chan" 5 => "P.C. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2008.03896.x" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2009" "volumen" => "29" "numero" => "4" "paginaInicial" => "387" "paginaFinal" => "396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19035982" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "[27]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development and implementation of a commissioned pathway for the identification and stratification of liver disease in the community" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Chalmers" 1 => "E. Wilkes" 2 => "R. Harris" 3 => "L. Kent" 4 => "S. Kinra" 5 => "G.P. Aithal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/flgastro-2019-101177" "Revista" => array:7 [ "tituloSerie" => "Frontline Gastroenterol" "fecha" => "2020" "volumen" => "11" "numero" => "2" "paginaInicial" => "86" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32066993" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "[28]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of implementing a “FIB-4 first” strategy on a pathway for patients with NAFLD referred from primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Davyduke" 1 => "P. Tandon" 2 => "M. Al-Karaghouli" 3 => "J.G. Abraldes" 4 => "M.M. Ma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep4.1411" "Revista" => array:7 [ "tituloSerie" => "Hepatol Commun." "fecha" => "2019" "volumen" => "3" "numero" => "10" "paginaInicial" => "1322" "paginaFinal" => "1333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31592044" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "[29]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Srivastava" 1 => "S. Jong" 2 => "A. Gola" 3 => "R. Gailer" 4 => "S. Morgan" 5 => "K. Sennett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12876-019-1039-4" "Revista" => array:6 [ "tituloSerie" => "BMC Gastroenterol" "fecha" => "2019" "volumen" => "19" "numero" => "1" "paginaInicial" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31296161" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "[30]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z.M. Younossi" 1 => "V. Ratziu" 2 => "R. Loomba" 3 => "M. Rinella" 4 => "Q.M. Anstee" 5 => "Z. Goodman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(19)33041-7" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2019" "volumen" => "394" "numero" => "10215" "paginaInicial" => "2184" "paginaFinal" => "2196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31813633" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "[31]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rise of sodium-glucose cotransporter 2 inhibitors in the management of nonalcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Dokmak" 1 => "M. Almeqdadi" 2 => "H. Trivedi" 3 => "S. Krishnan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4254/wjh.v11.i7.562" "Revista" => array:7 [ "tituloSerie" => "World J Hepatol" "fecha" => "2019" "volumen" => "11" "numero" => "7" "paginaInicial" => "562" "paginaFinal" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31388398" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack604527" "titulo" => "Acknowledgments" "texto" => "HDT is supported by 5T32DK007760-20. There are no other funding sources required for the production of this manuscript. There are no financial disclosures. There are no conflicts of interest. The corresponding author of this article is below 35 years of age (date of birth: June 11th, 1986).HDT, MPC and ML helped with idea creation. HDT, JS, DO, JS, DG, and RI helped with data acquisition. HDT performed statistical analysis and manuscript writing. MPC and ML performed critical revision.This project was approved by the international review board. This project has not been submitted or published in any other journal." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/000000240000000C/v7_202205201403/S1665268121000351/v7_202205201403/en/main.assets" "Apartado" => array:4 [ "identificador" => "78265" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/000000240000000C/v7_202205201403/S1665268121000351/v7_202205201403/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268121000351?idApp=UINPBA00004N"]

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Hirsh D. Trivedi

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htrived1@bidmc.harvard.edu

Corresponding author.

, Jaspreet Suri, Daheun Oh, Jeffrey Schwartz, Daniela Goyes, Rajab Idriss, Michael P. Curry, Michelle Lai

Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The incidence of nonalcoholic fatty liver disease &#40;NAFLD&#41; in the community is increasing&#44; along with the growth of obesity&#44; type 2 diabetes mellitus &#40;T2DM&#41; and other metabolic risk factors&#46; NAFLD is projected to be the leading cause of liver transplantation and contributes to significant morbidity and mortality worldwide &#91;<a class="elsevierStyleCrossRefs" href="#bib0005">1&#8211;5</a>&#93;&#46; The presence of T2DM&#44; in particular&#44; portends an increased risk of NAFLD&#44; nonalcoholic steatosis &#40;NASH&#41;&#44; advanced liver fibrosis and its related complications&#46; While screening for NAFLD in the general population is controversial&#44; there is growing consensus by international guidelines that patients with T2DM should be screened &#91;<a class="elsevierStyleCrossRefs" href="#bib0030">6&#8211;8</a>&#93;&#44; as they are at heightened risk for the more severe form of NAFLD and its complications &#91;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0050">10</a>&#93;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Type 2 diabetes is a known risk factor for NAFLD&#44; NASH and advanced fibrosis&#46; In a large meta-analysis from 22 countries&#44; the pooled prevalence of T2DM in NAFLD and NASH patients was 23&#37; and 44&#37;&#44; respectively&#44; estimates that are larger than the general population &#91;<a class="elsevierStyleCrossRef" href="#bib0005">1</a>&#93;&#46; T2DM is an independent predictor of advanced liver fibrosis &#91;<a class="elsevierStyleCrossRef" href="#bib0055">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0060">12</a>&#93;&#46; In a European NAFLD registry&#44; the presence of T2DM predicted advanced fibrosis with an odds ratio &#40;OR&#41; of 4&#46;68 &#40;95&#37; confidence interval &#91;CI&#93;&#58; 2&#46;17&#8211;10&#46;10&#44; P&#160;&#60;&#160;0&#46;001&#41;&#46; Additionally&#44; a study with serial liver biopsies showed the stage of fibrosis on index biopsy to be associated with T2DM &#40;P&#160;&#60;&#160;0&#46;001&#41; &#91;<a class="elsevierStyleCrossRef" href="#bib0065">13</a>&#93;&#46; In fact&#44; 80&#37; of patients who had fibrosis progression were diabetic&#44; compared to only 25&#37; of those who did not have fibrosis progression &#40;P&#160;&#61;&#160;0&#46;005&#41;&#46; Another biopsy-proven NAFLD cohort demonstrated increased liver-related &#40;adjusted hazard ratio &#91;aHR&#93;&#58; 2&#46;19&#44; 95&#37; CI&#58; 1&#8211;4&#46;81&#41; and overall mortality &#40;aHR&#58; 2&#46;09&#44; 95&#37; CI&#58; 1&#46;39&#8211;3&#46;14&#41; in those with diabetes &#91;<a class="elsevierStyleCrossRef" href="#bib0070">14</a>&#93;&#46; Hence&#44; targeting T2DM in the community where the burden of NAFLD is high&#44; and where general practitioners serve as the frontline&#44; is critical&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">NAFLD&#44; NASH and related fibrosis are the rule rather than the exception in patients with T2DM&#46; Reports estimate the presence of NAFLD and advanced fibrosis in outpatient T2DM cohorts to be significant &#91;<a class="elsevierStyleCrossRef" href="#bib0075">15</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0080">16</a>&#93;&#46; Given the high prevalence of T2DM in the community&#44; the screening of NAFLD would ideally take place in the primary care setting&#46; In fact&#44; the American Diabetes Association &#40;ADA&#41; guideline recommends evaluating for NAFLD at the time of diagnosis of T2DM or prediabetes and annually thereafter&#44; and for patients who have abnormal liver enzymes or steatosis on imaging&#44; they recommend evaluating for nonalcoholic steatohepatitis &#40;NASH&#41; and liver fibrosis&#44; along with a referral to a specialist &#91;<a class="elsevierStyleCrossRef" href="#bib0030">6</a>&#93;&#46; Other international guidelines&#44; including AASLD and EASL&#44; recommend noninvasive assessment of fibrosis in patients who are deemed high risk for NAFLD&#44; including those with T2DM &#91;<a class="elsevierStyleCrossRef" href="#bib0035">7</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0040">8</a>&#93;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fibrosis assessment in patients with NAFLD is crucial to prognosticate liver-related risk&#44; as those with advanced fibrosis and cirrhosis can develop HCC and portal hypertension&#44; increasing morbidity and mortality&#46; Liver biopsy remains the gold standard for the diagnosis of NAFLD and fibrosis&#44; but it is costly and involves risk &#91;<a class="elsevierStyleCrossRef" href="#bib0085">17</a>&#93;&#46; However&#44; several reliable noninvasive methods of fibrosis assessment have reduced the need for liver biopsy and provide a simple strategy for general practitioners to evaluate liver fibrosis&#46; The advent of transient elastography &#40;TE&#41; has revolutionized the evaluation of liver fibrosis &#91;<a class="elsevierStyleCrossRef" href="#bib0090">18</a>&#93;&#46; In fact&#44; TE scores accurately predict liver-related outcomes including advanced fibrosis&#44; cirrhosis&#44; portal hypertension and its sequelae &#91;<a class="elsevierStyleCrossRefs" href="#bib0095">19&#8211;21</a>&#93;&#46; At the moment&#44; TE is ordered and managed only by specialty hepatologists&#46; However&#44; improving accessibility of TE to general practitioners can facilitate early detection of high-risk NAFLD in the community and institute timely referral and treatment &#91;<a class="elsevierStyleCrossRef" href="#bib0110">22</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0115">23</a>&#93;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The need for a simple diagnostic pathway for general practitioners to assess liver fibrosis in high-risk patients &#40;i&#46;e&#46; T2DM&#41; is imperative&#46; Abnormal liver enzymes are historically unreliable &#91;<a class="elsevierStyleCrossRef" href="#bib0060">12</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0120">24&#8211;26</a>&#93;&#44; but remain the primary tool used to dictate specialist referral&#46; This leads to unnecessary referrals with specialists seeing patient&#8217;s with mild disease and advanced disease going unnoticed in the community&#46; Noninvasive measures&#44; however&#44; can reliably replace or be used in conjunction with liver enzyme tests&#46; Several studies in the United Kingdom &#40;UK&#41; demonstrate that the targeted use of noninvasive testing pathways in the community helps risk-stratify patient&#8217;s liver disease by fibrosis level&#44; reduces unnecessary specialist referrals&#44; and is cost-effective &#91;<a class="elsevierStyleCrossRefs" href="#bib0135">27&#8211;29</a>&#93;&#46; Improving accessibility of TE to general practitioners through a network referral system can help triage mild disease from more severe NAFLD that would warrant hepatology referral&#46; We created an open access TE referral program for patients from the community within our hospital network&#46; In this study&#44; we evaluated the association of T2DM in our primary care referral network with TE findings using this primary care based open access database&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0045">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">This is a retrospective cohort study of patients from an open access TE program created at Beth Israel Deaconess Medical Center &#40;BIDMC&#41; starting August 2017&#46; Primary care physicians &#40;PCPs&#41; within BIDMC and its network ordered liver stiffness measurement by TE&#46; PCPs were educated on the appropriate indications for TE referral through a series of expert lectures&#44; emails and handouts&#46; The referral indications included patients who were deemed high-risk for NAFLD with features of T2DM&#44; obesity&#44; metabolic syndrome&#44; or a family history of cryptogenic cirrhosis&#46; Other indications included abnormal liver enzymes&#44; steatosis or other abnormalities on liver imaging&#46; We collected data from 510 patients who had a TE from August 2017 to August 2019&#46; Patients were identified as having T2DM based on their problem list or presence of oral hypoglycemic or insulin in their medication list&#46; We excluded patients with a history of viral hepatitis&#44; alcohol-related liver disease or alcohol abuse&#44; which was defined as an excess of 14 beverages per week for males and 7 beverages per week for females &#40;N&#160;&#61;&#160;73 patients&#41; leaving us with a total sample size of 437 patients&#46; The remaining cohort of patients did not have other liver diseases&#44; biliary obstruction or hepatic malignancies&#44; as those patients were referred to the appropriate specialist &#40;i&#46;e&#46; hepatology&#41; and not included into this PCP-based TE referral pathway&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0050">Vibration-controlled transient elastography</span><p id="par0035" class="elsevierStylePara elsevierViewall">All patients in this study received liver stiffness measurement by TE &#40;FibroScan&#44; Echosens&#44; Paris&#44; France&#41;&#46; It was ensured that all included TE exams fulfilled the following criteria&#58; fasting state&#44; &#62;10 valid measurements&#44; and an interquartile range-to-median ratio &#40;IQR&#47;median&#41; &#60;30&#37;&#46; All measurements were started using the M probe&#44; and transitioned to the XL probe only if the initial measurement was inappropriate&#46; All patients also had controlled-attenuation parameter &#40;CAP&#41; measured during the TE exam to evaluate for steatosis&#46; A CAP score cut-off of &#8805; 248&#160;dB&#47;m was used to identify steatosis&#44; while a CAP score &#8805; 280&#160;dB&#47;m suggested severe steatosis&#46; A trained medical assistant performed the TE&#46; The findings were then evaluated by a hepatologist&#44; who provided referral recommendations to the primary care physician&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0055">Covariates</span><p id="par0040" class="elsevierStylePara elsevierViewall">Information on patient demographics and referral patterns was collected&#44; in addition to multiple clinical characteristics related to the patient&#8217;s liver disease and TE score findings&#46; This includes social history&#44; anthropometric measures&#44; laboratory values&#44; and imaging findings&#46; Patient comorbidities&#44; including the presence of coronary artery disease&#44; hyperlipidemia&#44; and obstructive sleep apnea&#44; were recorded after evaluating their problem list&#46; Data on heart failure or drugs causing steatosis were not collected&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0060">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The primary aim of this study was to evaluate the association of T2DM with TE score to inform whether patients with T2DM in our primary care referral population should be targeted for selective TE referral pathways&#46; The primary outcome of TE score was evaluated both as a continuous variable&#44; as well as binary categorical variables with different cut-offs of 7 and 10&#160;kPa&#46; A two-sided Student T-test was used to evaluate the association between the T2DM and continuous TE score given a normal distribution&#44; while a Pearson chi-square test was used to evaluate T2DM with the binary TE scores&#46; A secondary aim of the study was to evaluate the association of T2DM with the CAP score&#44; which was measured as a continuous variable and as separate dichotomous variables with cut-offs of 248&#160;dB&#47;m for steatosis and 280&#160;dB&#47;m for severe steatosis&#46; Two-sided T-test and Pearson chi-square test were used to evaluate continuous and categorical CAP scores&#44; respectively&#44; in the two samples&#46; Continuous variables were expressed as means with standard deviations&#46; Categorical variables were expressed as proportions with percentages &#40;&#37;&#41; and odds ratios &#40;OR&#41; with 95&#37; confidence intervals &#40;CI&#41;&#46; Stepwise multivariate linear and logistic regression was used to identify predictors of the outcomes and control for confounding&#46; Independent predictors were added to the multivariate model for the adjusted analysis&#46; A P-value below the set alpha level of 0&#46;05 was considered statistically significant&#46; Stata&#47;IC 15&#46;1 software was used for all statistical analysis&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0065">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0070">Baseline demographics</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> demonstrates the baseline characteristics of the study population&#46; There were a total of 124 patients with diabetes and 313 patients without diabetes&#46; Diabetic patients were older &#40;58&#160;&#177;&#160;11 vs 52&#160;&#177;&#160;13&#41;&#44; more likely to be female &#40;53&#37; vs 41&#37;&#41; and had a higher hemoglobin A1c &#40;HbA1c&#41; level &#40;7&#46;3&#160;&#177;&#160;1&#46;4 vs 5&#46;9&#160;&#177;&#160;3&#46;3&#41; compared to those without diabetes&#46; The predominant ethnicity in both groups was Caucasian consisting of 56&#37; and 65&#37; in the diabetic and non-diabetic groups&#44; respectively&#46; Body mass index &#40;BMI&#41;&#44; smoking status&#44; alanine aminotransferase &#40;ALT&#41; and platelet levels were not different between the two groups&#46; However&#44; the FIB-4 index score was significantly higher in those with diabetes compared to their counterparts &#40;1&#46;56&#160;&#177;&#160;1&#46;03 vs 1&#46;25&#160;&#177;&#160;0&#46;87&#41;&#46; This difference persisted when FIB-4 score was dichotomized into a binary score with a cut-off of 1&#46;45 &#40;P&#160;&#61;&#160;0&#46;008&#41;&#46; Additionally&#44; those with diabetes had a higher percentage of coronary artery disease &#40;13&#37; vs&#46; 2&#37;&#41;&#44; hyperlipidemia &#40;75&#37; vs 35&#37;&#41;&#44; and obstructive sleep apnea &#40;31&#37; vs&#46; 11&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0075">Transient elastography score</span><p id="par0055" class="elsevierStylePara elsevierViewall">The presence of T2DM was significantly associated with the TE score&#46; First and foremost&#44; when kept as a continuous measure&#44; patients with T2DM had a significantly higher TE score compared to those without diabetes &#40;8&#46;3&#160;kPa &#177; 6 vs 6&#46;4&#160;kPa &#177; 3&#46;7&#44; P-value&#160;&#61;&#160;0&#46;0001&#41;&#46; An unadjusted analysis demonstrated a beta-coefficient of 1&#46;83 &#40;95&#37; CI&#58; 0&#46;89&#8211;2&#46;77&#44; P&#160;&#60;&#160;0&#46;001&#41; as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Once adjusted for independent predictors&#44; including age&#44; BMI&#44; ALT&#44; HbA1c&#44; and steatosis on imaging&#44; the difference remained statistically significant &#40;beta-coefficient&#58; 1&#46;90&#44; 95&#37; CI&#58; 0&#46;74&#8211;3&#46;06&#44; P-value&#160;&#61;&#160;0&#46;001&#41;&#46; The TE score was then categorized into two separate cut-offs as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; When using a lower cut-off&#44; the unadjusted OR for diabetics having a TE score &#8805;7 kPa was 2&#46;42 &#40;95&#37; CI&#58; 1&#46;55&#8211;3&#46;77&#44; P&#160;&#60;&#160;0&#46;001&#41;&#46; After multivariate adjustment&#44; the OR increased to 2&#46;65 &#40;95&#37; CI&#58; 1&#46;50&#8211;4&#46;69&#44; P&#160;&#61;&#160;0&#46;001&#41;&#46; When using a higher TE score cut-off of 10&#160;kPa&#44; the unadjusted and adjusted OR were 2&#46;35 &#40;95&#37; CI&#58; 1&#46;31&#8211;4&#46;23&#44; P&#160;&#61;&#160;0&#46;004&#41; and 2&#46;08 &#40;95&#37; CI&#58; 1&#8211;4&#46;32&#44; P&#160;&#61;&#160;0&#46;049&#41;&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0080">Controlled attenuation parameter</span><p id="par0060" class="elsevierStylePara elsevierViewall">The presence of T2DM was also associated with CAP score&#44; an important measure of steatosis &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Table 2 and 3</a>&#41;&#46; The mean CAP score was significantly higher in those with T2DM compared to those without T2DM &#40;322&#160;&#177;&#160;51 vs 296&#160;&#177;&#160;57&#44; P&#160;&#60;&#160;0&#46;0001&#41;&#46; In an unadjusted analysis&#44; the beta-coefficient was 26 &#40;95&#37; CI&#58; 14&#46;3&#8211;37&#46;73&#44; P&#160;&#60;&#160;0&#46;001&#41;&#44; and remained statistically significant after multivariate adjustment for age&#44; BMI&#44; ALT and HbA1c levels &#40;beta-coefficient&#58; 22&#46;8&#44; 95&#37; CI&#58; 9&#46;33&#8211;36&#46;2&#44; P&#160;&#61;&#160;0&#46;001&#41;&#46; CAP score was then evaluated at two separate cut-offs with a score of &#8805;248&#160;dB&#47;m and &#8805;280&#160;dB&#47;m signifying the presence of steatosis and severe steatosis&#44; respectively&#46; When using the lower cut-off for steatosis&#44; the unadjusted odds ratio was 3&#46;23 &#40;95&#37; CI&#58; 1&#46;49&#8211;7&#44; P-value&#160;&#61;&#160;0&#46;003&#41;&#46; After adjusting for independent predictors&#44; the OR was 2&#46;18 &#40;95&#37; CI&#58; 0&#46;87&#8211;5&#46;41&#44; P&#160;&#61;&#160;0&#46;09&#41;&#46; When using the higher cut-off for severe steatosis&#44; the unadjusted &#40;OR&#58; 3&#46;27&#44; 95&#37; CI&#58; 1&#46;9&#8211;5&#46;63&#44; P&#160;&#60;&#160;0&#46;001&#41; and adjusted estimates &#40;OR&#58; 2&#46;33&#44; 95&#37; CI&#58; 1&#46;18&#8211;4&#46;60&#44; P&#160;&#61;&#160;0&#46;015&#41; remained significant&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The presence of T2DM impacts liver-related outcomes&#46; Patients with T2DM are more likely to have NAFLD&#44; advanced fibrosis&#44; and have an increased risk of mortality compared to those without diabetes &#91;<a class="elsevierStyleCrossRef" href="#bib0005">1</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0055">11&#8211;14</a>&#93;&#46; Screening for NAFLD remains controversial&#46; However&#44; there is growing consensus from international societies including ADA&#44; AASLD&#44; and EASL&#44; to noninvasively screen diabetics for liver fibrosis regardless of pre-existing NAFLD &#91;<a class="elsevierStyleCrossRefs" href="#bib0030">6&#8211;8</a>&#93;&#46; As seen in UK cohorts&#44; noninvasive screening pathways can facilitate appropriate referral&#44; reduce healthcare costs&#44; and also implement early intervention &#91;<a class="elsevierStyleCrossRefs" href="#bib0135">27&#8211;29</a>&#93;&#46; The reproducibility of such results in United States &#40;US&#41; based cohorts is warranted&#44; as treatments such as weight loss from lifestyle intervention or bariatric surgery&#44; as well as certain pharmacologic therapies on the horizon&#44; can alter the course of the disease if instituted early on &#91;<a class="elsevierStyleCrossRef" href="#bib0110">22</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0150">30</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0155">31</a>&#93;&#46; As the burden of NAFLD continues to grow worldwide&#44; screening patients with T2DM is crucial&#46; However&#44; the optimal method of noninvasive screening in the primary care population is not known&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">TE is a validated tool increasingly used in clinical practice to prognosticate patients with liver disease&#44; but its accessibility to general practitioners is limited&#46; Improving its access to physicians treating patients at risk for NAFLD&#44; such as those with T2DM&#44; is imperative to prevent under diagnosis and inappropriate referral that places burden on the healthcare system&#46; Improving access of TE to general practitioners&#44; who serve on the frontline&#44; can aid in the detection of NAFLD and advanced fibrosis&#46; In this study&#44; general practitioners had direct access to obtaining TE for their patients who were deemed to have high-risk of liver disease&#46; We evaluate the association of liver fibrosis and steatosis by TE with the presence of T2DM in this primary care referral population&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">TE scores accurately predict fibrosis and liver-related outcomes&#46; However&#44; studies on its use in patients at-risk of NAFLD within US-based primary care populations are limited&#46; In our study&#44; we demonstrate significantly higher TE and CAP scores in patients with T2DM in our primary care population compared to those without diabetes&#46; The statistical difference persists when categorizing the TE and CAP scores into distinct&#44; clinically relevant cut-offs&#46; The findings demonstrate that diabetics are at 2&#46;7 times the odds of having moderate-to-severe fibrosis &#40;&#8805;7 kPa&#44; P&#160;&#61;&#160;0&#46;001&#41; and at 2&#46;1 times the odds of having advanced fibrosis or cirrhosis &#40;&#8805;10&#160;kPa&#44; P&#160;&#61;&#160;0&#46;049&#41;&#46; Using CAP score&#44; diabetics also demonstrated increased odds of having any steatosis &#40;&#8805;248&#160;dB&#47;M&#44; OR&#58; 2&#46;18&#44; P&#160;&#61;&#160;NS&#41; or severe steatosis &#40;&#8805; 280&#160;dB&#47;m&#44; OR&#58; 2&#46;33&#44; P&#160;&#61;&#160;0&#46;015&#41;&#46; Not surprisingly&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; the proportion of diabetics progressively increases as the fibrosis level worsens based on TE score and FIB-4&#44; an alternate noninvasive measure of fibrosis&#46; Interestingly&#44; the ALT level in both groups were similar&#44; despite those with T2DM having increased amounts of steatosis and fibrosis&#46; These results exhibit similar trends seen in previous reports and can help guide general practitioners to determine further surveillance&#44; treatment and referral strategies&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Access to TE is limited only to specialty hepatologists at the moment&#46; However&#44; our study justifies the need for enhanced access of TE to general practitioners in order to prognosticate liver-related risk by improving detection of steatosis&#44; advanced liver fibrosis and cirrhosis in those with T2DM&#46; We show an increased risk of steatosis and advanced fibrosis by TE in patients with T2DM even without having a previous diagnosis of NAFLD&#44; justifying screening for all diabetics &#91;<a class="elsevierStyleCrossRef" href="#bib0030">6</a>&#93;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> illustrates a proposed pathway that general practitioners could use to determine the need for specialist referral based on TE score&#44; without having to rely on misleading liver enzyme tests or costly imaging techniques&#46; Enhanced TE access can potentially mitigate the under diagnosis of NAFLD in the community while also reducing unnecessary referrals to specialists and improving healthcare resource utilization&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">There are additional strengths and limitations in our study&#46; First off&#44; our reports of fibrosis and steatosis are consistent with previous studies in T2DM patients confirming its significant presence within primary care populations &#91;<a class="elsevierStyleCrossRef" href="#bib0075">15</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0080">16</a>&#93;&#46; The strong association of TE findings with the presence of T2DM has strong management implications that can potentially change clinical practice&#46; The generalizability of our results to other US-based primary care cohort populations serves as an additional strength of our study&#46; However&#44; although we did account for independent predictors to minimize confounding&#44; the observational and retrospective nature of the study makes it prone to unmeasured confounders that may ultimately influence the results&#46; Additionally&#44; the possibility of referral bias in our cohort indicates the need to replicate these results in a generalized primary care cohort with a simple and accessible method of fibrosis measurement&#44; which remains to be validated&#46; Lastly&#44; a propensity score matched study design would enhance the results of this study but requires a significantly larger sample size&#46; Hence&#44; longitudinal prospective studies validating these results and evaluating this algorithm within primary care clinics in the US are warranted&#46;<span class="elsevierStyleDefList"><span class="elsevierStyleSectionTitle" id="sect0090">Abbreviations</span><span class="elsevierStyleDefTerm">NAFLD</span><span class="elsevierStyleDefDescription"><p id="par0090" class="elsevierStylePara elsevierViewall">non-alcoholic liver disease</p></span><span class="elsevierStyleDefTerm">T2DM</span><span class="elsevierStyleDefDescription"><p id="par0095" class="elsevierStylePara elsevierViewall">type 2 diabetes mellitus</p></span><span class="elsevierStyleDefTerm">NASH</span><span class="elsevierStyleDefDescription"><p id="par0100" class="elsevierStylePara elsevierViewall">non-alcoholic steatohepatitis</p></span><span class="elsevierStyleDefTerm">OR</span><span class="elsevierStyleDefDescription"><p id="par0105" class="elsevierStylePara elsevierViewall">odds ratio</p></span><span class="elsevierStyleDefTerm">CI</span><span class="elsevierStyleDefDescription"><p id="par0110" class="elsevierStylePara elsevierViewall">confidence interval</p></span><span class="elsevierStyleDefTerm">HR</span><span class="elsevierStyleDefDescription"><p id="par0115" class="elsevierStylePara elsevierViewall">hazards ratio</p></span><span class="elsevierStyleDefTerm">ADA</span><span class="elsevierStyleDefDescription"><p id="par0120" class="elsevierStylePara elsevierViewall">American Diabetes Association</p></span><span class="elsevierStyleDefTerm">AASLD</span><span class="elsevierStyleDefDescription"><p id="par0125" class="elsevierStylePara elsevierViewall">American Association for the Study of Liver Disease</p></span><span class="elsevierStyleDefTerm">EASL</span><span class="elsevierStyleDefDescription"><p id="par0130" class="elsevierStylePara elsevierViewall">European Association for the Study of the Liver</p></span><span class="elsevierStyleDefTerm">HCC</span><span class="elsevierStyleDefDescription"><p id="par0135" class="elsevierStylePara elsevierViewall">hepatocellular carcinoma</p></span><span class="elsevierStyleDefTerm">TE</span><span class="elsevierStyleDefDescription"><p id="par0140" class="elsevierStylePara elsevierViewall">transient elastography</p></span><span class="elsevierStyleDefTerm">UK</span><span class="elsevierStyleDefDescription"><p id="par0145" class="elsevierStylePara elsevierViewall">United Kingdom</p></span><span class="elsevierStyleDefTerm">BIDMC</span><span class="elsevierStyleDefDescription"><p id="par0150" class="elsevierStylePara elsevierViewall">Beth Israel Deaconess Medical Center</p></span><span class="elsevierStyleDefTerm">PCP</span><span class="elsevierStyleDefDescription"><p id="par0155" class="elsevierStylePara elsevierViewall">primary care physicians</p></span><span class="elsevierStyleDefTerm">CAP</span><span class="elsevierStyleDefDescription"><p id="par0160" class="elsevierStylePara elsevierViewall">controlled-attenuation parameter</p></span><span class="elsevierStyleDefTerm">kPa</span><span class="elsevierStyleDefDescription"><p id="par0165" class="elsevierStylePara elsevierViewall">kilopascals</p></span><span class="elsevierStyleDefTerm">HbA1c</span><span class="elsevierStyleDefDescription"><p id="par0170" class="elsevierStylePara elsevierViewall">hemoglobin A1c</p></span><span class="elsevierStyleDefTerm">BMI</span><span class="elsevierStyleDefDescription"><p id="par0175" class="elsevierStylePara elsevierViewall">body-mass index</p></span><span class="elsevierStyleDefTerm">ALT</span><span class="elsevierStyleDefDescription"><p id="par0180" class="elsevierStylePara elsevierViewall">alanine aminotransferase</p></span><span class="elsevierStyleDefTerm">FIB-4</span><span class="elsevierStyleDefDescription"><p id="par0185" class="elsevierStylePara elsevierViewall">fibrosis-4 index</p></span><span class="elsevierStyleDefTerm">NS</span><span class="elsevierStyleDefDescription"><p id="par0190" class="elsevierStylePara elsevierViewall">not significant</p></span></span></p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Noninvasive liver assessment in type 2 diabetes &#40;T2DM&#41; in a primary care population identifies higher risk non-alcoholic fatty liver disease &#40;NAFLD&#41;&#46; We aimed to evaluate the association of T2DM with liver fibrosis and steatosis by transient elastography &#40;TE&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and Methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective study of a TE referral program where primary care physicians were able to order TE&#46; Patients with alcohol abuse were excluded&#46; TE and Controlled Attenuation Parameter &#40;CAP&#41; scores were obtained&#46; Multivariable linear and logistic regression models were used to adjust for confounders&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">28&#37; had T2DM&#46; The mean TE score in T2DM patients was 8&#46;3 &#40;&#177;6&#41; kilopascal &#40;kPa&#41; and 6&#46;4 &#40;&#177;3&#46;7&#41; kPa in those without T2DM &#40;p&#160;&#61;&#160;0&#46;0001&#41;&#46; Those with T2DM had a higher CAP &#40;322&#160;&#177;&#160;51&#160;dB&#47;m vs&#46; 296&#160;&#177;&#160;57&#160;dB&#47;m&#44; p&#160;&#60;&#160;0&#46;0001&#41;&#46; In multivariable analysis&#44; T2DM was associated with TE score &#40;&#946;&#58; 1&#46;9&#44; 95&#37; confidence interval &#91;CI&#93;&#58; 0&#46;74&#8211;3&#46;1&#44; p&#160;&#61;&#160;0&#46;001&#41; and CAP &#40;&#946;&#58; 2&#46;8&#44; 95&#37; CI&#58; 9&#46;3&#8211;36&#46;2&#44; p&#160;&#61;&#160;0&#46;001&#41;&#46; Patients with T2DM had higher-risk TE scores and more steatosis by CAP&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">T2DM is associated with liver fibrosis and steatosis by TE within a primary care population&#46; A TE referral pathway may be utilized for T2DM patients who are at higher risk of NAFLD and its complications&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a&#58; This figure illustrates the proportion of type 2 diabetes patients within individual transient elastography risk categories&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">b&#58; This figure illustrates the percentage of type 2 diabetics within FIB-4 risk categories &#40;N&#160;&#61;&#160;338&#41;&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes &#40;N&#160;&#61;&#160;124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No Diabetes &#40;N&#160;&#61;&#160;313&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;4 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;4 &#40;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female &#40;&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;41&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ethnicity</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caucasian</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">197 &#40;64&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;54&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hispanic</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;16&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">African American</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;16&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asian</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;5 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;4 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking &#40;&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Never</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">192 &#40;68&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;056</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Former</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;34&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT Level &#40;IU&#47;L&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;9 &#40;30&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;7 &#40;39&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Platelet Level &#40;K&#47;uL&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">244&#46;1 &#40;67&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">246&#46;4 &#40;71&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HbA1c &#40;&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;3 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FIB-4 Score &#40;points&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;56 &#40;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;25 &#40;0&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" colspan="2">FIB-4 Stage</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low &#40;&#60;1&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169 &#40;72&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;58&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indeterminate-or-high &#40;&#8805; 1&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;41&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Steatosis on Imaging</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;86&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142 &#40;76&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coronary Artery Disease</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperlipidemia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#40;34&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obstructive Sleep Apnea</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CAP Score &#40;dB&#47;m&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">322&#46;1 &#40;51&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">296&#46;1 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Steatosis by CAP&#40;&#8805;248&#160;dB&#47;m&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;93&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">245 &#40;81&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe Steatosis by CAP&#40;&#8805;280&#160;dB&#47;m&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102 &#40;84&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187 &#40;62&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TE Score &#40;kPa&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" colspan="2">TE Score Category</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 7 kPa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">241 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;58&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805; 7 kPa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;41&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 10&#160;kPa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">284 &#40;90&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;80&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805; 10&#160;kPa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;19&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" colspan="2">TE Probe</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M probe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">214 &#40;68&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">XL probe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;31&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;46&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2911063.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Baseline Characteristics of Study Population&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Independent predictors that were adjusted for in the multivariate linear regression model were age&#44; BMI&#44; ALT level&#44; HbA1c&#46; Steatosis on imaging was kept in the TE outcome model&#44; but not used for CAP score&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#44; TE&#58; transient elastography&#44; CAP&#58; controlled attenuation parameter&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Unadjusted Estimate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted Estimate</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Continuous Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#946;-coefficient &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#946;-coefficient&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TE Score &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;83&#40;0&#46;89&#8211;2&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;90&#40;0&#46;74&#8211;3&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CAP Score &#40;dB&#47;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;02&#40;14&#46;3&#8211;37&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                        "volumen" => "64"
                        "numero" => "1"
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                          "autores" => array:6 [
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                    0 => array:2 [
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                        "tituloSerie" => "Hepatology"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27543837"
                            "web" => "Medline"
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                          "etal" => true
                          "autores" => array:5 [
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                            3 => "S&#46;C&#46; Lu"
                            4 => "L&#46; Le Marchand"
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                            2 => "K&#46;P&#46; Batts"
                            3 => "K&#46;D&#46; Lindor"
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                    0 => array:2 [
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                        "numero" => "6"
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                        "paginaFinal" => "1362"
                        "link" => array:1 [
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                            5 => "G&#46;J&#46; Gores"
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                    0 => array:2 [
                      "doi" => "10.1002/hep.510240222"
                      "Revista" => array:3 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2019"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8690415"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of advanced fibrosis in non-cirrhotic non-alcoholic fatty liver disease in Germany"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "Y&#46; Huber"
                            2 => "E&#46; Kalliga"
                            3 => "M&#46; Nagel"
                            4 => "C&#46; Ruckes"
                            5 => "B&#46;K&#46; Straub"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Aliment Pharmacol Ther"
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                        "volumen" => "48"
                        "numero" => "10"
                        "paginaInicial" => "1109"
                        "paginaFinal" => "1116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30288767"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Mofrad"
                            1 => "M&#46;J&#46; Contos"
                            2 => "M&#46; Haque"
                            3 => "C&#46; Sargeant"
                            4 => "R&#46;A&#46; Fisher"
                            5 => "V&#46;A&#46; Luketic"
                          ]
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                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Hepatology"
                        "fecha" => "2003"
                        "volumen" => "37"
                        "numero" => "6"
                        "paginaInicial" => "1286"
                        "paginaFinal" => "1292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12774006"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
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              "identificador" => "bib0065"
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                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:6 [
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                            1 => "T&#46; Hardy"
                            2 => "E&#46; Henderson"
                            3 => "A&#46;D&#46; Burt"
                            4 => "C&#46;P&#46; Day"
                            5 => "Q&#46;M&#46; Anstee"
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                    0 => array:2 [
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                        "tituloSerie" => "J Hepatol"
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                        "numero" => "5"
                        "paginaInicial" => "1148"
                        "paginaFinal" => "1155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25477264"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0070"
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                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => true
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                            2 => "H&#46; Makhlouf"
                            3 => "R&#46; Agrawal"
                            4 => "I&#46; Kaur"
                            5 => "Z&#46; Younoszai"
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                    0 => array:2 [
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                        "tituloSerie" => "Dig Dis Sci"
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                        "numero" => "10"
                        "paginaInicial" => "3017"
                        "paginaFinal" => "3023"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23775317"
                            "web" => "Medline"
                          ]
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                            3 => "Y&#46; Zhang"
                            4 => "H&#46;L&#46; Chan"
                            5 => "A&#46;O&#46; Luk"
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                    ]
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                        "numero" => "8"
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                        "paginaFinal" => "1368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25873639"
                            "web" => "Medline"
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                    0 => array:2 [
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                        "paginaFinal" => "95"
                        "link" => array:1 [
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                        "paginaFinal" => "1304"
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                        "paginaFinal" => "1268"
                        "link" => array:1 [
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                        "link" => array:1 [
                          0 => array:2 [
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                        "tituloSerie" => "Am J Med"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7102710"
                            "web" => "Medline"
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                    0 => array:2 [
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                        0 => array:2 [
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                        "paginaInicial" => "1953"
                        "paginaFinal" => "1997"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25433429"
                            "web" => "Medline"
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                        "tituloSerie" => "Aliment Pharmacol Ther"
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                          "etal" => true
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                            5 => "G&#46;P&#46; Aithal"
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                        "tituloSerie" => "Frontline Gastroenterol"
                        "fecha" => "2020"
                        "volumen" => "11"
                        "numero" => "2"
                        "paginaInicial" => "86"
                        "paginaFinal" => "92"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32066993"
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                          "etal" => false
                          "autores" => array:5 [
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                            2 => "M&#46; Al-Karaghouli"
                            3 => "J&#46;G&#46; Abraldes"
                            4 => "M&#46;M&#46; Ma"
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                        "volumen" => "3"
                        "numero" => "10"
                        "paginaInicial" => "1322"
                        "paginaFinal" => "1333"
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                    0 => array:2 [
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                        0 => array:2 [
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                        "tituloSerie" => "BMC Gastroenterol"
                        "fecha" => "2019"
                        "volumen" => "19"
                        "numero" => "1"
                        "paginaInicial" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31296161"
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                    ]
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                ]
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                        0 => array:2 [
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                            3 => "M&#46; Rinella"
                            4 => "Q&#46;M&#46; Anstee"
                            5 => "Z&#46; Goodman"
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                        ]
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                        "volumen" => "394"
                        "numero" => "10215"
                        "paginaInicial" => "2184"
                        "paginaFinal" => "2196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31813633"
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                        "tituloSerie" => "World J Hepatol"
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                        "paginaFinal" => "573"
                        "link" => array:1 [
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        "texto" => "<p id="par0195" class="elsevierStylePara elsevierViewall">HDT is supported by 5T32DK007760-20&#46; There are no other funding sources required for the production of this manuscript&#46; There are no financial disclosures&#46; There are no conflicts of interest&#46; The corresponding author of this article is below 35 years of age &#40;date of birth&#58; June 11th&#44; 1986&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">HDT&#44; MPC and ML helped with idea creation&#46; HDT&#44; JS&#44; DO&#44; JS&#44; DG&#44; and RI helped with data acquisition&#46; HDT performed statistical analysis and manuscript writing&#46; MPC and ML performed critical revision&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">This project was approved by the international review board&#46; This project has not been submitted or published in any other journal&#46;</p>"
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Article information

ISSN: 16652681
Original language: English

DOI:10.1016/j.aohep.2021.100336

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Year/Month	Html	Pdf	Total

2024 November	4	0	4
2024 October	26	5	31
2024 September	59	5	64
2024 August	57	4	61
2024 July	58	6	64
2024 June	51	4	55
2024 May	76	14	90
2024 April	59	14	73
2024 March	52	13	65
2024 February	103	30	133
2024 January	108	12	120
2023 December	87	11	98
2023 November	87	12	99
2023 October	94	23	117
2023 September	72	9	81
2023 August	59	5	64
2023 July	61	7	68
2023 June	52	14	66
2023 May	95	14	109
2023 April	66	7	73
2023 March	72	6	78
2023 February	51	9	60
2023 January	76	10	86
2022 December	68	12	80
2022 November	54	10	64
2022 October	50	17	67
2022 September	49	34	83
2022 August	59	25	84
2022 July	45	12	57
2022 June	46	15	61
2022 May	83	22	105
2022 April	62	15	77
2022 March	82	22	104
2022 February	71	10	81
2022 January	62	7	69
2021 December	27	9	36
2021 November	34	9	43
2021 October	34	9	43
2021 September	47	8	55
2021 August	22	2	24
2021 July	23	2	25
2021 June	21	2	23
2021 May	19	2	21
2021 April	9	15	24
2021 March	8	10	18
2021 February	0	3	3

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