The Performance of Enhanced Liver Fibrosis (ELF) Test for the Staging of Liver Fibrosis: A Meta-Analysis

Abstract

BackgroundThe enhanced liver fibrosis test (ELF) has been shown to accurately predict significant liver fibrosis in several liver diseases.AimsTo perform a meta-analysis to assess the performance of the ELF test for the assessment of liver fibrosis.StudyElectronic and manual searches were performed to identify studies of the ELF test. After methodological quality assessment and data extraction, pooled estimates of the sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and summary receiver operating characteristics (sROC) were assessed systematically. The extent of heterogeneity and reasons for it were assessed.ResultsNine studies were identified for analysis. The pooled sensitivity, specificity, positive LR, negative LR, and DOR values of ELF test, for assessment of significant liver fibrosis, were 83% (95% CI = 0.80–0.86), 73% (95% CI = 0.69–0.77), 4.00 (95% CI = 2.50–6.39), 0.24 (95% CI = 0.17–0.34), and 16.10 (95% CI = 8.27–31.34), respectively; and, for evaluation of severe liver fibrosis, were 78% (95% CI = 0.74–0.81), 76% (95% CI = 0.73–0.78), 4.39 (95% CI = 2.76–6.97), 0.27 (95% CI = 0.16–0.46), and 16.01 (95% CI: 7.15–35.82), respectively; and, for estimation of cirrhosis, were 80% (95% CI = 0.75–0.85), 71% (95% CI = 0.68–0.74), 3.13 (95% CI = 2.01–4.87), 0.29 (95% CI = 0.19–0.44), and 14.09 (95% CI: 5.43–36.59), respectively.ConclusionsThe ELF test shows good performance and considerable diagnostic value for the prediction of histological fibrosis stage.

Enhanced liver fibrosis test predicts transplant‐free survival in primary sclerosing cholangitis, a multi‐centre study

“…The Enhanced Liver Fibrosis (ELF) test is a promising panel, incorporating three direct serum markers of fibrosis in an algorithm: hyaluronic acid, tissue inhibitor of metalloproteinases-1 (TIMP-1), and amino-terminal pro-peptide of type III procollagen (PIIINP). [10,11] The ELF test was shown to accurately predict significant liver fibrosis and was furthermore able to predict clinical outcome in several independent populations and in patients with various etiologies of chronic liver disease. [12][13][14][15][16] Recently, the prognostic value of the ELF test in PSC was assessed in a large single center study from Norway including two independent PSC cohorts.…”

Multiplex Serum Protein Analysis Identifies Novel Biomarkers of Advanced Fibrosis in Patients with Chronic Liver Disease with the Potential to Improve Diagnostic Accuracy of Established Biomarkers

“…The available complex panels perform similarly for the detection of advanced fibrosis[5, 6], with reported area under the receiver-operating curve (AUROC) values of 0.8–0.9. However, a recent meta-analysis of nine studies evaluating the ELF test reported median sensitivity/specificity values of 78%/76% for advanced fibrosis, although the data-driven diagnostic cut-offs applied in different studies were a major cause of heterogeneity[7]. Using the ELF manufacturer’s cut-off for advanced fibrosis (≥9.8), we demonstrated 92% specificity and 74% sensitivity for the detection of advanced fibrosis in a mixed etiology CLD cohort[8].…”

Isolated Hepatitis B Core Antibody Status Is Not Associated With Accelerated Liver Disease Progression in HIV/Hepatitis C Coinfection

“…In our study, the marker was useful both as a continuous and as a categorical variable to look at the effect of isolated anti-HBc on fibrosis progression. Although hepatitis C is the most well-studied, ELF has been shown to correlate well with fibrosis severity in other hepatic diseases including hepatitis B, fatty liver, alcoholic liver disease and primary biliary cirrhosis 25,26,31–33 . ELF has been found to correlate with clinical outcomes as well.…”

“…Tests were performed according to the manufacturer’s instructions at iQur Limited London, UK. The performance of ELF has been reported using the area under the receiver operating curve (AUROC) to describe its ability to detect histologically classified mild, moderate or severe fibrosis in chronic hepatitis C liver biopsies with excellent sensitivity and specificity 25,26 .…”