Enhanced Liver Fibrosis (ELF) test accurately identifies liver fibrosis in patients with chronic hepatitis C

Abstract

Summary

Assessment of liver fibrosis is important in
determining prognosis and evaluating interventions. Due
to limitations of accuracy and patient hazard of liver
biopsy, non-invasive methods have been sought to provide
information on liver fibrosis, including the European liver
fibrosis (ELF) test, shown to have good diagnostic accuracy
for the detection of moderate and severe fibrosis. Access to
independent cohorts of patients has provided an opportunity
to explore if this test could be simplified. This paper
reports the simplification of the ELF test and its ability to identity severity of liver fibrosis in external validation studies in patients with chronic hepatitis C (CHC).

Paired biopsy and serum samples from 347 na?¨ve patients with CHC in three independent cohorts were analysed. Diagnostic performance characteristics were derived (AUROC,
sensitivity and specificity, predictive values), and clinical utility modelling performed to determine the proportion of biopsies that could have been avoided if ELF test was used in this patient group. It was possible to simplify the original ELF test without loss of performance and the new algorithm is reported. The simplified ELF test was able to predict severe fibrosis [pooled AUROC of 0.85 (95% CI 0.81–0.89)] and using clinical utility modelling to predict severe fibrosis (Ishak stages 4–6; METAVIR stages 3 and 4) 81% of biopsies could have been avoided (65% correctly).

Issues of spectrum effect in diagnostic test
evaluations are discussed. In chronic hepatitis C a simplified ELF test can detect severe liver fibrosis with good accuracy.

More information

Identifiers

ORCID for J. Parkes: orcid.org/0000-0002-6490-395X

ORCID for P. Roderick: orcid.org/0000-0001-9475-6850

Catalogue record

Export record

Altmetrics