In addition to lower PRO scores in patients withbiopsy-proven NASH, we have made similar observationsregarding NASH patients with higher ELF scores. Thisfinding not only corroborates the association of PROswith the histologic data, but it also allows for indirectvalidation of ELF as an accurate correlate of both hepaticfibrosis and PROs. In this context, because of the lack ofassociation of HRQL with other histologic features ofNASH (lobular inflammation, ballooning, and steatosis), itseems that the primary driver of PRO impairment inNASH is fibrosis. This adds to evidence that the stage offibrosis is also the only predictor of liver-related mortality in NASH.36 On the other hand, the current studydoes not allow any conclusion about the potential association of changes in fibrosis or resolution of NASH withPROs. Because these endpoints are set by regulatoryagencies for clinical trials of NASH at the present time,future studies are needed to assess improvement offibrosis without worsening NASH or resolution of NASHwithout worsening fibrosis on PROs.