Enhanced Liver Fibrosis Score as a Predictor of Hepatocellular Carcinoma

Loo, Wai Mun; Goh, George Boon‐Bee; Wang, Yeli; Yuan, Jian‐Min; Ong, Lizhen; Dan, Yock Young; Koh, Woon‐Puay

doi:10.1373/clinchem.2018.289108

Cited by 7 publications

(8 citation statements)

References 5 publications

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Section: Introductionmentioning

confidence: 89%

“…It was recently reported that the ELF score was comparable with transient elastography in detecting advanced fibrosis (F≥3) in treatment-naïve patients with chronic HCV infection (16). In addition, the usefulness of ELF score as a predictor of HCC in the general population, Enhanced liver fibrosis score as a predictive marker for hepatocellular carcinoma development after hepatitis C virus eradication particularly in predicting non-viral-related HCC, was previously reported (17). Among these fibrosis markers, M2BPGi and FIB-4 index were reported to be useful markers for the risk of HCC development after HCV eradication (18,19).…”

Section: Introductionmentioning

confidence: 90%

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Enhanced liver fibrosis score as a predictive marker for hepatocellular carcinoma development after hepatitis C virus eradication

et al. 2021

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Advanced liver fibrosis is the most important risk factor for hepatocellular carcinoma (HCC) development after achieving sustained virological response (SVR) by direct-acting antiviral (DAA) treatment in patients with chronic hepatitis C. Wisteria floribunda agglutinin-positive Mac-2-binding protein (M2BPGi), enhanced liver fibrosis (ELF) score, type IV collagen and fibrosis-4 (FIB-4) index have been reported as non-invasive biomarkers for liver fibrosis. In the present study, the possibility of using fibrosis biomarkers and other parameters to predict the development of HCC was evaluated. A total of 743 patients infected with hepatitis C virus who achieved SVR by using DAA were retrospectively enrolled. Of these, 122 patients whose blood samples were stored were selected. The aforementioned four fibrosis biomarkers were analyzed at baseline, at the end of treatment (EOT) and at post-treatment week 24 (PTW24). Tumor markers and laboratory tests were also analyzed. The baseline/EOT/PTW24 values for each fibrosis biomarker were as follows: ELF score: 11.5±1.2/10.8±1.1/10.4±1.0; type IV collagen: 213±85/190±67/174±55 ng/ml; M2BPGi: 4.8±3.5/2.7±2.0/2.2±1.8; and FIB-4 index: 5.31±3.82/4.36± 2.79/4.24±3.09. Of the 122 patients, 23 developed HCC. A high baseline ELF score (P=0.0264), PTW24 ELF score (P=0.0003), PTW24 α-fetoprotein level (P=0.0133), baseline FIB-4 index (P=0.0451) and low baseline prothrombin time (P=0.0455) were risk factors for HCC development based on univariate analyses. Based on the multivariate analysis, a high PTW24 ELF score was the only risk factor for HCC development (P=0.0035). The ELF score after DAA therapy was strongly associated with HCC development; therefore, it may be a useful marker for predicting HCC.

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 90%

Enhanced liver fibrosis score as a predictive marker for hepatocellular carcinoma development after hepatitis C virus eradication

et al. 2021

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“…A few other serum biomarkers measure different components of fibrosis 54,55,57–64 In clinical practice, ELF is the first serum biomarker for which the FDA has given a de novo marketing authorisation for assessment of prognosis in advanced fibrosis among patients with NASH. The ELF score which consists of serum levels for three matrix turnover proteins (hyaluronic acid, TIMP‐1 and PIIINP) has an AUROC of 0.90 with 80% sensitivity and 90% specificity for detecting advanced fibrosis.…”

Section: Noninvasive Tests For Fibrosismentioning

confidence: 99%

“…The ELF score uses two distinct cut off values to determine risk of fibrosis. Specifically, ELF score <9.8 indicates low risk, ELF score ≥ 9.8 < 11.3 indicates mid risk and a score ≥11.3 indicates higher risk for advanced fibrosis 53,54,57–64 . Additionally, ELF is a prognostic test where a unit increase in ELF score is associated with a doubling of risk 60 .…”

Section: Noninvasive Tests For Fibrosismentioning

confidence: 99%

A practical use of noninvasive tests in clinical practice to identify high‐risk patients with nonalcoholic steatohepatitis

Younossi

Alkhouri

Cusi

et al. 2022

Aliment Pharmacol Ther

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Summary Background Patients with nonalcoholic fatty liver disease (NAFLD) with type 2 diabetes (T2D) or other components of metabolic syndrome are at high risk for disease progression. We proposed an algorithm to identify high‐risk NAFLD patients in clinical practice using noninvasive tests (NITs). Methods Evidence about risk stratification of NAFLD using validated NITs was reviewed by a panel of NASH Experts. Using the most recent evidence regarding the performance of NITs and their application in clinical practice were used to develop an easy‐to‐use algorithm for risk stratification of NAFLD patients seen in primary care, endocrinology and gastroenterology practices. Results The proposed algorithm uses a three‐step process to identify NAFLD patients who are potentially at high risk for adverse outcomes. The first step is to use clinical data to identify most patients who are at risk for having potentially progressive NAFLD (e.g. having T2D or multiple components of metabolic syndrome). The second step is to calculate the FIB‐4 score as a NIT that can further risk stratifying individuals who are at low risk for progressive liver disease and can be managed by their primary healthcare providers to manage their cardiometabolic comorbidities. The third step is to use second‐line NITs (transient elastography or enhanced liver fibrosis tests) to identify those who at high risk for progressive liver disease and should be considered for specially care by providers with NASH expertise. Conclusions The use of this simple clinical algorithm can identify and assist in managing patients with NAFLD at high risk for adverse outcomes.

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“…The ELF test has been shown to predict clinical outcomes in mixed liver disease [9,37], and in disease-specific populations, for example primary sclerosing cholangitis [53] and chronic hepatitis C [54]. A study in the general population evaluated the performance of the ELF test to predict development of hepatocellular carcinoma, demonstrating that an ELF score of ≥9.89 had an odds ratio of 25 for predicting an event [55].…”

Section: Other Studiesmentioning

confidence: 99%

The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease

et al. 2020

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Background: Chronic liver disease (CLD) is usually asymptomatic but earlier detection is critical to permit lifesaving interventions for those at risk due to high alcohol consumption and increased body mass index (BMI). The aim of this study was to estimate the association between the Enhanced Liver Fibrosis (ELF) test and liver-related events (LRE) and its performance in predicting LRE in postmenopausal women with risk factors in a nested case-control study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS).Methods: In a cohort of 95,126 we performed a case-control study measuring ELF in blinded samples from 173 participants with self-reported high alcohol use and / or BMI ≥25 kg/m 2 comprising all 58 cases who developed LRE and 115 controls matched for age, alcohol and BMI who did not develop LRE during median follow-up of 8.5 years.Results: Using Cox regression at an ELF threshold of 10.51 hazard ratios (HR) for LRE were 4.88 (95% confidence interval (CI) 2.37-10.03) (unadjusted model) and 4.62 (95% CI 2.12-10.08) (adjusted for deprivation and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes). At a threshold of 9.8 HR for LRE were 2.21 (95% CI 1.22-3.97) (unadjusted model) and 2.18 (95% CI 1.19-4.01) (adjusted). ELF was evaluated as a time dependent variable by generating time-dependent Cox models; HRs at an ELF threshold of 10.51 were 1.94 (95% CI 1.10-3.39) (unadjusted) and 2.05 (95% CI 1.16-3.64) (adjusted) and at a threshold of 9.8 HRs were 1.85 (95% CI 1.09-3.15) (unadjusted) and 1.80 (95% CI 1.04-3.13) (adjusted). Area under the receiver operating characteristic curve for recruitment ELF predicting LRE was 0.58 (95% CI 0.49-0.68), and for second subsequent ELF 0.61 (95% CI 0.52-0.71). Conclusion:This study demonstrates the association between ELF and CLD in postmenopausal women with risk factors for liver disease, creating the opportunity to intervene to reduce liver-related mortality and morbidity. Although larger studies are required, these results demonstrate the potential of ELF as a prognostic tool in health checks in primary care.(Continued on next page)

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Enhanced Liver Fibrosis Score as a Predictor of Hepatocellular Carcinoma

Cited by 7 publications

References 5 publications

Enhanced liver fibrosis score as a predictive marker for hepatocellular carcinoma development after hepatitis C virus eradication

Enhanced liver fibrosis score as a predictive marker for hepatocellular carcinoma development after hepatitis C virus eradication

A practical use of noninvasive tests in clinical practice to identify high‐risk patients with nonalcoholic steatohepatitis

The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease

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