The Enhanced liver fibrosis score is associated with clinical outcomes and disease progression in patients with chronic liver disease

Katharine M Irvine, Leesa F Wockner, Mihir Shanker, Kevin J Fagan, Leigh U Horsfall, Linda M Fletcher, Jacobus P J Ungerer, Carel J Pretorius, Gregory C Miller, Andrew D Clouston, Guy Lampe, Elizabeth E Powell

Current tools for risk stratification of chronic liver disease subjects are limited. We aimed to determine whether the serum-based ELF (Enhanced Liver Fibrosis) test predicted liver-related clinical outcomes, or progression to advanced liver disease, and to compare the performance of ELF to liver biopsy and non-invasive algorithms. 300 patients with ELF scores assayed at the time of liver biopsy were followed up (median 6.1 years) for liver-related clinical outcomes (n=16) and evidence of progression to advanced fibrosis (n=18), by review of medical records and clinical data. Fourteen of 73 (19.2%) patients with ELF score indicative of advanced fibrosis (≥9.8, the manufacturer's cut-off) had a liver-related clinical outcome, compared to only 2 of 227 (<1%) patients with ELF score <9.8. By contrast, the simple scores APRI and FIB-4 would only have predicted subsequent decompensation in 6 and 4 patients, respectively. A unit increase in ELF score was associated with a 2.53-fold increased risk of a liver-related event (adjusted for age and stage of fibrosis). In patients without advanced fibrosis on biopsy at recruitment, 61% (11/18) with an ELF score ≥9.8 showed evidence of progression to advanced fibrosis (after an average 6 years), whereas only 13.5% of those with an ELF score <9.8 (28/207) progressed (average 14 years). In these subjects, a unit increase in ELF score was associated with a 4.34-fold increased risk of progression. Conclusions The ELF score is a valuable tool for risk stratification of patients with chronic liver disease. This article is protected by copyright. All rights reserved.