Age serves as the silent architect of FIB-4’s precision in unveiling advanced hepatic fibrosis in MASLD with T2DM: Correspondence to letter to the editor on “Diagnostic accuracy of the fibrosis-4 index for advanced liver fibrosis in nonalcoholic fatt

We sincerely appreciate the interest of Wang et al. in our study. 1,2Type 2 diabetes mellitus (T2DM) is a critical risk factor in the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD).The co-incidence rate of T2DM and MASLD is very high across all regions globally. 3All MASLD are candidates for hepatic fibrosis evaluation, and those with coexisting T2DM are classified as a high-risk group for which hepatic fibrosis evaluation is essential. 4However, concerns have been raised regarding the low diagnostic performance of fibrosis-4 index (FIB-4) in assessing hepatic fibrosis in T2DM for various reasons.To address these concerns, researchers have extensively investigated the diagnostic perfor-mance of FIB-4 for advanced hepatic fibrosis in T2DM patients.Our meta-analysis data showed moderate sensitivity and specificity, with an overall diagnostic accuracy represented by the hierarchical summary receiver operating characteristic curve (HSROC) value at a low cutoff.The sensitivity, specificity, and HSROC were 0.74, 0.62, and 0.75, respectively. 2The concerns raised by Wang et al. regarding our metaanalysis are both reasonable and appropriate. 1First, our study included both cross-sectional and cohort studies without distinguishing between them.Generally, study design can influence the level of evidence, and therefore, in meta-analyses, studies are usually analyzed separately based on their design.In our case, the primary endpoint of our study was to evaluate the diagnostic performance of Age serves as the silent architect of FIB-4's precision in unveiling advanced hepatic fibrosis in MASLD with T2DM