ELF score ≥9.8 indicates advanced hepatic fibrosis and is influenced by age, steatosis and histological activity

Fagan, Kevin J., Pretorius, Carel J., Horsfall, Leigh U., Irvine, Katharine M., Wilgen, Urs, Choi, Kihoon, Fletcher, Linda M., Tate, Jill, Melino, Michelle, Nusrat, Sharmin, Miller, Gregory C., Clouston, Andrew D., Ballard, Emma, O'Rourke, Peter, Lampe, Guy, Ungerer, Jacobus P. J. and Powell, Elizabeth E. (2015) ELF score ≥9.8 indicates advanced hepatic fibrosis and is influenced by age, steatosis and histological activity. Liver International, 35 6: 1673-1681. doi:10.1111/liv.12760

Author Fagan, Kevin J.
Pretorius, Carel J.
Horsfall, Leigh U.
Irvine, Katharine M.
Wilgen, Urs
Choi, Kihoon
Fletcher, Linda M.
Tate, Jill
Melino, Michelle
Nusrat, Sharmin
Miller, Gregory C.
Clouston, Andrew D.
Ballard, Emma
O'Rourke, Peter
Lampe, Guy
Ungerer, Jacobus P. J.
Powell, Elizabeth E.
Title ELF score ≥9.8 indicates advanced hepatic fibrosis and is influenced by age, steatosis and histological activity
Journal name Liver International   Check publisher's open access policy
ISSN 1478-3231
Publication date 2015-06
Year available 2015
Sub-type Article (original research)
DOI 10.1111/liv.12760
Open Access Status
Volume 35
Issue 6
Start page 1673
End page 1681
Total pages 9
Place of publication Malden, MA United States
Publisher Wiley-Blackwell Publishing
Collection year 2016
Language eng
Formatted abstract
Background & Aims
There is increasing need to identify individuals with advanced liver fibrosis, who are at risk of complications such as hepatocellular carcinoma. The commercially available enhanced liver fibrosis (ELF) test provides a non-invasive assessment of fibrosis severity. This study was designed to determine the diagnostic accuracy of the manufacturer's cut-off value (≥9.8) in identifying advanced fibrosis.

The relationship between ELF score and fibrosis was examined using serum collected at time of liver biopsy for investigation of liver disease, particularly viral hepatitis. Fibrosis was staged using a modified METAVIR score. If available, liver tissue was recut and stained with Sirius red to determine collagen proportional area (CPA) and subsinusoidal fibrosis (SSF).

Enhanced liver fibrosis score ≥9.8 had a sensitivity of 74.4% and specificity 92.4% for detecting advanced fibrosis. In the whole cohort (n = 329), ELF score was more likely to incorrectly classify individuals if age was ≥45 years and METAVIR inflammatory grade was 2 or 3 (adjusted OR, odds ratio 3.71 and 2.62 respectively). In contrast, ELF score was less likely to misclassify individuals in the presence of steatosis (OR 0.37). Neither SSF nor CPA explained the discordance in ELF score for patients with or without advanced fibrosis.

Although ELF score ≥9.8 reliably identifies advanced fibrosis in patients with chronic liver disease, both age and inflammatory activity need to be considered when interpreting the result. Importantly, ELF score performed well in the presence of steatosis and could thus be helpful in the assessment of fatty liver disease.
Keyword Biomarker
Collagen proportional area
Non-alcoholic fatty liver disease
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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