A two-step screening strategy for significant fibrosis by MEFIB and the summary of the diagnostic ability of MEFIB. As a first screening step in a primary care center, FIB-4 could be applied for the first screening as a readily available blood-based test. Patients with FIB-4 < 1.6 need no further examination, and patients with FIB-4 ≥ 1.6 need a further examination at a referral care center. As a second step, MRE could be applied. Patients with the MEFIB rule-in criteria (MRE ≥ 3.3 kPa and FIB-4 ≥ 1.6) have a high PPV for significant fibrosis (95%) and are good candidates for clinical trials. Furthermore, patients with the MEFIB rule-out criteria (MRE < 3.3 kPa and FIB-4 < 1.6) have a high NPV (90%) for significant fibrosis (PPV for nonsignificant fibrosis), and these patients could be followed up by a repeat blood-based test (FIB-4)