Performance of the Enhanced Liver Fibrosis Test to Estimate Advanced Fibrosis Among Patients With Nonalcoholic Fatty Liver Disease

Younossi, Zobair M.; Felix, Sean; Jeffers, Thomas L.; Younossi, Elena; Nader, Fatema; Pham, Huong; Afendy, Arian; Cable, Rebecca; Racila, Andrei; Younoszai, Zahra; Lam, Brian; Golabi, Pegah; Henry, Linda; Stepanova, Maria

doi:10.1001/jamanetworkopen.2021.23923

Cited by 40 publications

(38 citation statements)

References 33 publications

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“…In the study by Harrison et al, the ELF test demonstrated satisfying accuracy for detecting significant (cutoff −0.2) and advanced fibrosis (cutoff −0.1) among NASH patients [ 20 ]. Younossi et al reported very high specificity of the ELF test and good reliability in ruling in patients with advanced fibrosis (cutoffs 9.8 and 11.3) among NAFLD patients with biopsy and VCTE as reference tools [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…This SLR provides a comprehensive current overview of diagnostic tools for detection and monitoring of NASH-related liver fibrosis staging based on the summarized evidence from the US studies. The diagnostic accuracy was validated against liver biopsy as a standard diagnostic tool in all studies, except for the Caussy et al study where both liver biopsy and MRE were used [ 29 ], and that of Younossi et al where VCTE and biopsy were reference tools [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of Noninvasive Diagnostic Tests for the Detection of Significant and Advanced Fibrosis Stages in Nonalcoholic Fatty Liver Disease: A Systematic Literature Review of the US Studies

Gosalia

Ratziu²,

Stanicic³

et al. 2022

Diagnostics

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Background: The purpose of this systematic literature review (SLR) was to evaluate the accuracy of noninvasive diagnostic tools in detecting significant or advanced (F2/F3) fibrosis among patients with nonalcoholic fatty liver (NAFL) in the US healthcare context. Methods: The SLR was conducted in PubMed and Web of Science, with an additional hand search of public domains and citations, in line with the PRISMA statement. The study included US-based original research on diagnostic test sensitivity, specificity and accuracy. Results: Twenty studies were included in qualitative evidence synthesis. Imaging techniques with the highest diagnostic accuracy in F2/F3 detection and differentiation were magnetic resonance elastography and vibration-controlled transient elastography. The most promising standard blood biomarkers were NAFLD fibrosis score and FIB-4. The novel diagnostic tools showed good overall accuracy, particularly a score composed of body mass index, GGT, 25-OH-vitamin D, and platelet count. The novel approaches in liver fibrosis detection successfully combine imaging techniques and blood biomarkers. Conclusions: While noninvasive techniques could overcome some limitations of liver biopsy, a tool that would provide a sufficiently sensitive and reliable estimate of changes in fibrosis development and regression is still missing.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Accuracy of Noninvasive Diagnostic Tests for the Detection of Significant and Advanced Fibrosis Stages in Nonalcoholic Fatty Liver Disease: A Systematic Literature Review of the US Studies

Gosalia

Ratziu²,

Stanicic³

et al. 2022

Diagnostics

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“…Another study that investigated the diagnostic accuracy of ELF in 829 patients with NAFLD demonstrated that the AUROC for advanced fibrosis was 0.81. Furthermore, the performance of ELF was similar regardless of age or diabetes mellitus 32 . Another study demonstrated that the diagnostic accuracy of ELF is comparable to an imaging‐based modality 33 …”

Section: Noninvasive Fibrosis Markers In Nafldmentioning

confidence: 90%

“…Furthermore, the performance of ELF was similar regardless of age or diabetes mellitus. 32 Another study demonstrated that the diagnostic accuracy of ELF is comparable to an imaging-based modality. 33 Type IV collagen 7S is a fragment of type IV collagen, which consists basement membrane.…”

Section: Direct Fibrosis Markersmentioning

confidence: 99%

Noninvasive assessment of liver fibrosis and its clinical significance in nonalcoholic fatty liver disease

Tamaki

Kurosaki

Huang

et al. 2022

Hepatology Research

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Liver fibrosis is the most important prognostic factor in patients with nonalcoholic fatty liver disease (NAFLD). Several noninvasive markers for fibrosis, including blood‐based markers and imaging based‐markers have been developed. Indirect fibrosis markers (e.g., fibrosis‐4 index and NAFLD fibrosis score) consist of standard laboratory data and clinical parameters. Given its availability and high negative predictive value for advanced fibrosis, these markers are suitable for screening at primary care. Blood‐based fibrogenesis markers (enhanced liver fibrosis and N‐terminal propeptide of type 3 collagen), ultrasound‐based modalities (vibration‐controlled transient elastography, point shear wave elastography [SWE], and two‐dimensional SWE), and magnetic resonance elastography have high diagnostic accuracy for liver fibrosis and are suitable for diagnosing liver fibrosis at secondary care centers. Sequential use of these markers can increase diagnostic accuracy and reduce health care costs. Furthermore, combining noninvasive makers may assist in identifying candidates for pharmacological trials and reducing screening failure. Emerging data suggest that these noninvasive markers are associated with liver‐related events (hepatocellular carcinoma and decompensation) and mortality. Furthermore, delta change in noninvasive markers over time is also associated with time‐course change in fibrosis, liver‐related event risk, and mortality risk. However, the association between liver fibrosis and cardiovascular disease (CVD) risk is still controversial. CVD risk may decrease in patients with decompensated liver disease and noninvasive markers may be useful for assessing CVD risk in these patients. Therefore, noninvasive markers may be utilized as measures of fibrosis as well as real‐time prognostic tools, in place of liver biopsy.

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“…[ 55 ] Combining the ELF score < 7.2 with the FIB‐4 score < 0.74 may provide even greater sensitivity (92.5%) for ruling out advanced fibrosis. [ 56 ] Given the probability of more rapid progression of NASH in patients with AGHD, all patients with suspected liver fibrosis ≥ stage 2 should be followed closely by a hepatologist. Figure 2 represents a suggested screening algorithm.…”

Section: Screening Patients With Aghd For Nafld?mentioning

confidence: 99%

Growth hormone deficiency and NAFLD: An overlooked and underrecognized link

2022

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Growth hormone and its mediator insulin‐like growth factor‐1 exert their effect on different organs and control various physiologic metabolic processes. Adult growth hormone deficiency (AGHD) presents with one or more components of metabolic syndrome and can be associated with nonalcoholic fatty liver disease (NAFLD). AGHD is present in spectrum of hypothalamic/pituitary disorders as well as cranial radiation of brain tumors and often remains underdiagnosed or untreated due to its nonspecific symptoms, relatively difficult diagnosis in some clinical scenarios, and various barriers to treatment. NAFLD usually develops soon after diagnosis of AGHD and might progress rapidly to nonalcoholic steatohepatitis (NASH) with advanced fibrosis, eventually requiring liver transplantation. A timely initiation of growth hormone replacement therapy might be important, although studies so far have demonstrated controversial results on NAFLD, primarily due to small sample size and different diagnostic methods of NAFLD. Increased awareness of the association between AGHD and NAFLD would facilitate early diagnosis of NAFLD and NASH if present. Therefore, a multidisciplinary approach involving hepatology and endocrinology should become a standard of care for these patients.

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Performance of the Enhanced Liver Fibrosis Test to Estimate Advanced Fibrosis Among Patients With Nonalcoholic Fatty Liver Disease

Abstract: This cross-sectional study investigates use of the noninvasive enhanced liver fibrosis test to estimate advanced fibrosis among patients with nonalcoholic fatty liver disease.

Cited by 40 publications

References 33 publications

Accuracy of Noninvasive Diagnostic Tests for the Detection of Significant and Advanced Fibrosis Stages in Nonalcoholic Fatty Liver Disease: A Systematic Literature Review of the US Studies

Accuracy of Noninvasive Diagnostic Tests for the Detection of Significant and Advanced Fibrosis Stages in Nonalcoholic Fatty Liver Disease: A Systematic Literature Review of the US Studies

Noninvasive assessment of liver fibrosis and its clinical significance in nonalcoholic fatty liver disease

Growth hormone deficiency and NAFLD: An overlooked and underrecognized link

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