Z Gastroenterol 2018; 56(05): e41
DOI: 10.1055/s-0038-1654642
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

Enhanced liver fibrosis (ELF) score accurately detects advanced fibrosis in nonalcoholic fatty liver disease (NAFLD)

K Staufer
1   Department of Surgery, Vienna, Austria
,
R Marculescu
2   Department of Laboratory Medicine, Vienna, Austria
,
B Obermayer-Pietsch
3   Department of Internal Medicine, Graz, Austria
,
J Stift
4   Department of Pathology, Vienna, Austria
,
C Lackner
5   Institute of Pathology, Graz, Austria
,
M Trauner
6   University Department of Medicine III, Vienna, Austria
,
R Stauber
3   Department of Internal Medicine, Graz, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
09 May 2018 (online)

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    Background and Aims:

    The Enhanced Liver Fibrosis (ELF) test is a noninvasive fibrosis panel composed of hyaluronic acid (HA), procollagen-3 N-terminal peptide (P3NP), and tissue inhibitor of metalloproteinase-1 (TIMP1). Nonalcoholic steatohepatitis (NASH) with advanced fibrosis (F3) or cirrhosis (F4) causes increased liver-related mortality. Noninvasive tests are needed to identify patients with these advanced stages of NASH who are eligible for enrolment in clinical trials. Aim of the present study was to determine the diagnostic accuracy of ELF score for prediction of advanced fibrosis/cirrhosis in non-alcoholic fatty liver disease (NAFLD) with or without NASH.

    Methods:

    We enrolled consecutive patients with NAFLD admitted to two Austrian outpatient liver clinics who underwent liver biopsy. Histological NASH was defined as presence of steatosis > 5%, hepatocellular ballooning and lobular inflammation. Fibrosis was staged according to the clinical research network (CRN) score. Serum samples obtained at the time of liver biopsy were used to perform ELF test (Siemens Health Care, Vienna, Austria). The predictive value of ELF score for diagnosis of fibrosis stage was assessed by receiver operating characteristic (ROC) analysis and compared to two simple fibrosis tests based on routine parameters, i.e. NAFLD fibrosis score (NFS) and FIB-4.

    Results:

    Our study cohort contained 188 patients with NAFLD. On liver histology, NASH was present in 111 patients (59%) and advanced fibrosis stage (F3 – 4) in 49 patients (26%). ELF score was significantly higher in fibrosis stages F3 – 4 vs. F0 – 2 (10.5 [9.6, 11.7] vs. 8.5 [8.1, 9.2], p < 0.001). ROC analysis revealed superior diagnostic accuracy of ELF score (AUROC 0.89) vs. NFS (AUROC 0.80) or FIB-4 (AUROC 0.85) for prediction of fibrosis stage F3 – 4.

    Conclusion:

    Based on our findings, ELF score accurately predicts advanced fibrosis in NAFLD and thus may be very useful to assess eligibility of NAFLD patients for clinical trials with anti-inflammatory and/or antifibrotic drugs.


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