## 4 Discussion  
We found that hepatic steatosis has a significant effect on liver fibrosis measurements by TE or FIB4 in both the biopsy and non-biopsy groups. While this phenomenon mainly occurred in patients with NAFLD or CHC, it also occurred with low effect in those with CHB. To better understand the value and limitations of CAP, we correlated CAP with semi-quantified fat cell fraction by liver histology. The correlation was linear in all participants (R\({}^{2}\) linear = 0.615) and reached a plateau when the CAP value was \(\geq\) 290 dB/m (R\({}^{2}\) linear = 0.009). Our findings are consistent with those of previous studies. [28; 29] Based on this observation, we divided our patients into high and low CAP groups using a cutoff value of 290 dB/m. \begin{table}
\begin{tabular}{l l l l l l l l l l} \hline \hline  & \multicolumn{4}{c}{**CAP \(<\) 290 dB/m**} & \multicolumn{4}{c}{**CAP \(\geq\) 290 dB/m**} & \multicolumn{2}{c}{**Cutoff**} \\ \cline{2-10}  & **AUROC** & **Cutoff** & **Sensitivity** & **Specificity** & **AUROC** & **Cutoff** & **Sensitivity** & **Specificity** & **Difference** & **\% * \\ \hline \multicolumn{10}{c}{F4 (N = 10 vs. \textless{}F4 (N = 54)} & \multicolumn{4}{c}{F4 (N = 7) vs. \textless{}F4 (N = 81)} & \\ \hline ARFI m/s & 0.911 & 1.655 & 0.800 & 0.852 & 0.949 & 1.695 & 0.857 & 0.889 & \(-\)0.04 & \(-\)2.4\% \\ TE kPa & 0.914 & 13.00 & 0.900 & 0.852 & 0.959 & 11.90 & 0.857 & 0.877 & 1.1 & 8.5\% \\ FIB4 & 0.824 & 2.417 & 0.800 & 0.741 & 0.905 & 1.675 & 0.857 & 0.815 & 0.742 & 30.7\% \\ \hline \multicolumn{10}{c}{F3-4 (N = 32) vs. \textless{}F3 (N = 32)} & \multicolumn{4}{c}{F3-4 (N = 24) vs. \textless{}F3 (N = 64)} & \\ \hline ARFI m/s & 0.938 & 1.290 & 0.813 & 0.875 & 0.882 & 1.273 & 0.833 & 0.797 & 0.017 & 1.3\% \\ TE kPa & 0.928 & 9.25 & 0.813 & 0.844 & 0.886 & 9.000 & 0.792 & 0.797 & 0.25 & 2.7\% \\ FIB4 & 0.896 & 1.762 & 0.781 & 0.719 & 0.795 & 1.251 & 0.708 & 0.703 & 0.511 & 29.0\% \\ \hline \multicolumn{10}{c}{F2-4 (N = 29) vs. \textless{}F2 (N = 35)} & \multicolumn{4}{c}{F2-4 (N = 31) vs. \textless{}F2 (N = 57)} & \\ \hline ARFI m/s & 0.917 & 1.225 & 0.866 & 0.897 & 0.838 & 1.243 & 0.806 & 0.772 & \(-\)0.018 & \(-\)1.5\% \\ TE kPa & 0.905 & 8.850 & 0.829 & 0.828 & 0.891 & 8.750 & 0.839 & 0.789 & 0.1 & 1.1\% \\ FIB4 & 0.885 & 1.641 & 0.800 & 0.739 & 0.797 & 1.229 & 0.742 & 0.737 & 0.412 & 25.1\% \\ \hline \hline \end{tabular}
* Compared with cutoff value in CAP \(<\) 290 dB/m group.  
\end{table} 
Table 4: Effect of hepatic steatosis on cutoff values of liver fibrosis scores in NAFLD and CHC patients. \begin{table}
\begin{tabular}{l l l l l l l} \hline \hline  & \multicolumn{4}{c}{**CAP \(<\)290 dB/m**} & \multicolumn{2}{c}{**CAP \(\geq\) 290 dB/m**} & \multicolumn{2}{c}{**Flurosis score**} & \multicolumn{1}{c}{**No**} & \multicolumn{1}{c}{**Mean \(\pm\) SD**} & \multicolumn{1}{c}{**No**} & \multicolumn{1}{c}{**Mean \(\pm\) SD**} & \multicolumn{1}{c}{**\(p\) Value**} \\ \hline \multirow{4}{*}{Mean ARFI (m/sec)} & \(\geq\)2 & 39 & 1.57 \(\pm\) 0.63 & 11 & 1.67 \(\pm\) 0.56 & 0.631 \\  & \(\geq\)1 & 49 & 1.46 \(\pm\) 0.60 & 18 & 1.49 \(\pm\) 0.54 & 0.845 \\  & Total & 52 & 1.43 \(\pm\) 0.60 & 18 & 1.49 \(\pm\) 0.54 & 0.718 \\ \hline \multirow{2}{*}{TE (kPa)} & \(\geq\)2 & 39 & 12.14\(\pm\) 9.14 & 11 & 12.69 \(\pm\) 5.75 & 0.852 \\  & \(\geq\)1 & 43 & 10.94 \(\pm\) 8.61 & 16 & 10.37 \(\pm\) 5.56 & 0.798 \\  & Total & 52 & 10.58 \(\pm\) 8.48 & 18 & 10.37 \(\pm\) 5.56 & 0.923 \\ \hline \multirow{2}{*}{FIB4} & \(\geq\)2 & 39 & 2.53 \(\pm\) 1.50 & 11 & 1.88 \(\pm\) 0.99 & 0.189 \\  & \(\geq\)1 & 43 & 2.35 \(\pm\) 1.54 & 16 & 1.56 \(\pm\) 0.94 & 0.046 \\ \cline{1-1}  & Total & 52 & 2.29 \(\pm\) 1.52 & 18 & 1.56 \(\pm\) 0.94 & 0.059 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: _Cont._In the non-biopsy training group, the correlation between TE and ARFI was good for all three etiologies (Figure 2a). However, the linear regression slopes differed between the high and low CAP patients among the NBNC and CHC subgroups (Figure 2a).