Enhanced liver fibrosis test can predict clinical outcomes in patients with chronic liver disease

Parkes, Julie; Roderick, Paul; Harris, Scott; Day, Christopher P.; Mutimer, David; Collier, Jane; Lombard, Martin; Alexander, Graeme; Ramage, John; Dusheiko, Geoffrey; Wheatley, Mark; Gough, C; Burt, Alastair D.; Rosenberg, William

doi:10.1136/gut.2009.203166

Cited by 289 publications

(294 citation statements)

References 32 publications

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“…22 Further studies have used the AST/platelet count ratio and the commercial ELF test (a combination of HA, P3NP, and tissue inhibitor metalloproteinase [TIMP]), which predicted survival in 457 subjects with a range of liver diseases, with an AUROC of 0.87. 23 All these outcome data are essentially similar to the findings of the present study and the study would conclude that the various non-invasive tests including the STL, mSTL, FibroTest, ELF and APRI appear to have similar accuracy in predicting outcomes, and, given the accuracy of cirrhosis prediction in general, are probably equally likely to be able to define a population at risk of variceal haemorrhage.…”

Section: Comparison With Existing Literaturesupporting

confidence: 77%

Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Sheron¹,

Moore²,

Ansett³

et al. 2012

Br J Gen Pract

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Section: Comparison With Existing Literaturesupporting

confidence: 77%

Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Sheron¹,

Moore²,

Ansett³

et al. 2012

Br J Gen Pract

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“…In recent years, a commercial enhanced liver fibrosis (ELF) test that non-invasively measures the degree of liver fibrosis has been introduced in human medicine. It assesses three main markers of liver fibrosis -hyaluronic acid (HA), type III procollagen aminopeptide (PIIINP) and the inhibitor of the precursor of metalloproteinase-1 (TIMP1) (Rosenberg et al 2004, Parkes et al 2010, Pinzani 2010). …”

Section: Discussionmentioning

confidence: 99%

Serum concentrations of PIIINP aminopeptide in dogs with liver fibrosis

Glińska-Suchocka¹,

Orłowska²,

Jankowski³

et al. 2016

Polish Journal of Veterinary Sciences

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The aim of the study was to evaluate the serum concentration of the type III procollagen aminopeptide in dogs, and to assess its utility in the diagnosis of liver fibrosis. The study was carried out on 20 dogs of different breeds and of both genders, between 7 and 15 years old. Based on the results of the histopathological examination and the evaluation of the degree of liver fibrosis, the dogs were divided into five groups. The mean serum PIIINP concentration in the group of dogs with stage 1 and 2 liver fibrosis (groups 2 and 3) was five-fold higher than in healthy dogs (group 1). In turn, the mean PIIINP concentration in the group of dogs with stage 3 (group 4) and stage 4 (group 5) fibrosis was 10-fold higher than that of the control group (group 1). Based on the results, we found that the serum PIIINP concentration correlated with the degree of liver fibrosis, assessed based on a histopathological examination. Therefore, PIIINP serum concentration tests may be a promising non-invasive diagnostic technique that could be used in veterinary hepatology to assess the degree of liver fibrosis.

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“…159,171 The ELF panel has a predictability of 90% for severe fibrosis, 82% for moderate fibrosis and 76% for no fibrosis in patients with NA-FLD 172 using the modified Brunt criteria, 173,174 and it has a near perfect association with Brunt fibrosis stage ≥3 in paediatric patients with NAFLD. 175 The ELF test also has a predictability of 85% for severe fibrosis (Ishak fibrosis stages 4-6) in patients with chronic hepatitis C. 171 Clinical utility models suggest that 81% of liver biopsy examinations for severe fibrosis in chronic hepatitis C 171 and 82% of liver biopsy examinations in NA-FLD 172 can be avoided by the ELF test.…”

Section: Elf Test For Hepatic Fibrosismentioning

confidence: 99%

“…Unlike the other non-invasive biomarkers of hepatic fibrosis, the ELF test has been applied to a broad spectrum of chronic liver diseases, including autoimmune hepatitis. 159 Its limited use in autoimmune hepatitis has not established its preference or validity in this disease. The experience, however, does support its candidacy as a test of interest.…”

Section: Elf Test For Hepatic Fibrosismentioning

confidence: 99%

“…159 Comparative studies have not been performed with the ELF test in diverse chronic liver diseases, and the published studies of this test have not been suitable for inclusion in meta-analysis. 157 Nevertheless, the clinical experiences with the ELF test have justified its inclusion among the promising non-invasive laboratory markers of hepatic fibrosis.…”

Section: Elf Test For Hepatic Fibrosismentioning

confidence: 99%

See 1 more Smart Citation

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Czaja

2014

Aliment Pharmacol Ther

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SummaryBackgroundImmunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti‐fibrotic effects are inconsistent secondary gains.AimTo describe the anti‐fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti‐fibrotic interventions, indicate the non‐invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities.MethodsStudies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti‐fibrotic therapy and non‐invasive tests of hepatic fibrosis were selected.ResultsHepatic fibrosis improves in 53–57% of corticosteroid‐treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non‐invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non‐invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti‐fibrotic therapies are poised for study in this disease.ConclusionsThe prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti‐fibrotic interventions, must be evaluated.

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Enhanced liver fibrosis test can predict clinical outcomes in patients with chronic liver disease

Abstract: An ELF test can predict clinical outcomes in patients with chronic liver disease and may be a useful prognostic tool in clinical practice.

Cited by 289 publications

References 32 publications

Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Serum concentrations of PIIINP aminopeptide in dogs with liver fibrosis

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

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