Introduction: Non-alcoholic fatty liver disease (NAFLD) is chronic liver disease strongly associated with metabolic syndrome and its components. NAFLD is one of the most common chronic diseases and a growing etiological factor for liver cirrhosis and hepatocellular carcinoma. In the future, it will become the main indication for liver transplatation. Therefore, it is important to develope non-invasive methods of detection and monitoring of at-risk patients. Aim: Aim of this study was to assess the diagnostic accuracy of elastographic parameters of steatosis (controlled attenuation parameter, CAP) and fibrosis (liver stiffness measurement, LSM) measured by either M or XL probes, biochemical markers (M30, M65, APRI and FIB-4) and their combination against liver biopsy which is a gold standard in detection of liver steatosis and fibrosis, as well as nonalcoholic steatohepatitis (NASH). Methods: This study was retrospective study that in the included 146 nonalcoholic fatty liver disease (NAFLD) patients. We used the Fibroscan® 502 Touch operating software. Results: We found that CAP identified NAFLD patients with steatosis with an AUROC of 0.92 for S≥S1, 0.8 for S≥S2, and 0.86 for S≥S3, with the corresponding cutoff values 296 dB/m, 327 dB/m and 368 dB/m, respectively. LSM identified NAFLD patients with fibrosis with AUROCs of 0.90 for F≥F1, 0.91 for F≥F2 and 0.87) for F≥F3, with the cutoff values of 8.5kPa, 9.5kPa and 13.6kPa, respectively. FIB-4, APRI and cell death markers M30 and M65 were also found to be useful in detecting each fibrosis stage. Conclusion: With the application of both biochemical testing and transient elastography, we can timely detect patients with significant histological changes as well as identify those that do not require further workup (liver biopsy) which should result in better patient care and substantial long-term savings