Comment on: FIB-4 as an effective screening tool in psoriatic arthritis patients at high-risk for liver disease: a cross-sectional study using FibroScan

Dear Editor, We read with interest the study by Meridor et al. ‘FIB-4 as an effective screening tool in psoriatic arthritis patients at high-risk for liver disease: a cross-sectional study using FibroScan’, recently published in Rheumatology [1]. The authors provide valuable, practice-oriented insights into liver risk stratification for metabolic dysfunction-associated steatotic liver disease (MASLD) in high-risk psoriatic arthritis (PsA). They assessed three non-invasive tools—Fibrosis-4 (FIB-4), Enhanced Liver Fibrosis (ELF) and BMI, AST/ALT ratio, and Diabetes (BARD)—for detecting clinically significant liver disease (CSLD) and emphasized the strong negative predictive value (NPV) of FIB-4 (cut-off ≥1.3) as a potential rule-out step. However, several statistical and reporting issues merit clarification before these findings are applied to routine care. First, several statistical inconsistencies require explanation. In Table 1, the univariable P-value for the total: HDL cholesterol ratio >3.5 is reported as 0.61. Using the authors’ counts, the χ2 statistic is 15.128 (P < 0.05). Conversely, triglycerides >2.3 mmol/l is reported as significant (P = 0.02), but recalculation yields a χ2 statistic of 0.394 (P ≈ 0.53), indicating no significant difference between the two groups. Hypertension is recorded as 40/89 overall; however, Table 1 lists 31 cases in the CSLD group and 7 in the non-CSLD group, totalling 38. Therefore, it is necessary to provide justification for excluding two individuals from the group. Transparent reporting of missing data and statistical results is vital for readers to replicate the findings and assess bias [2].