The Enhanced liver fibrosis score is associated with clinical outcomes and disease progression in patients with chronic liver disease

Irvine, Katharine M., Wockner, Leesa F., Shanker, Mihir, Fagan, Kevin J., Horsfall, Leigh U., Fletcher, Linda M., Ungerer, Jacobus P. J., Pretorius, Carel J., Miller, Gregory C., Clouston, Andrew D., Lampe, Guy and Powell, Elizabeth E. (2015) The Enhanced liver fibrosis score is associated with clinical outcomes and disease progression in patients with chronic liver disease. Liver International, 36 3: 370-377. doi:10.1111/liv.12896


Author Irvine, Katharine M.
Wockner, Leesa F.
Shanker, Mihir
Fagan, Kevin J.
Horsfall, Leigh U.
Fletcher, Linda M.
Ungerer, Jacobus P. J.
Pretorius, Carel J.
Miller, Gregory C.
Clouston, Andrew D.
Lampe, Guy
Powell, Elizabeth E.
Title The Enhanced liver fibrosis score is associated with clinical outcomes and disease progression in patients with chronic liver disease
Journal name Liver International   Check publisher's open access policy
ISSN 1478-3231
1478-3223
Publication date 2015-08-28
Year available 2015
Sub-type Article (original research)
DOI 10.1111/liv.12896
Open Access Status Not Open Access
Volume 36
Issue 3
Start page 370
End page 377
Total pages 8
Place of publication Malden, Massachusetts, United States
Publisher Wiley-Blackwell Publishing
Collection year 2016
Language eng
Formatted abstract
Background and Aims
Current tools for risk stratification of chronic liver disease subjects are limited. We aimed to determine whether the serum-based ELF (Enhanced Liver Fibrosis) test predicted liver-related clinical outcomes, or progression to advanced liver disease, and to compare the performance of ELF to liver biopsy and non-invasive algorithms.

Methods
Three hundred patients with ELF scores assayed at the time of liver biopsy were followed up (median 6.1 years) for liver-related clinical outcomes (n = 16) and clear evidence of progression to advanced fibrosis (n = 18), by review of medical records and clinical data.

Results

Fourteen of 73 (19.2%) patients with ELF score indicative of advanced fibrosis (≥9.8, the manufacturer's cut-off) had a liver-related clinical outcome, compared to only two of 227 (<1%) patients with ELF score <9.8. In contrast, the simple scores APRI and FIB-4 would only have predicted subsequent decompensation in six and four patients respectively. A unit increase in ELF score was associated with a 2.53-fold increased risk of a liver-related event (adjusted for age and stage of fibrosis). In patients without advanced fibrosis on biopsy at recruitment, 55% (10/18) with an ELF score ≥9.8 showed clear evidence of progression to advanced fibrosis (after an average 6 years), whereas only 3.5% of those with an ELF score <9.8 (8/207) progressed (average 14 years). In these subjects, a unit increase in ELF score was associated with a 4.34-fold increased risk of progression.

Conclusions
The ELF score is a valuable tool for risk stratification of patients with chronic liver disease.
Keyword Liver cirrhosis
Decompensation
Liver cancer
Non-invasive biomarkers
Prediction of clinical outcomes
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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