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Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis

Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis
Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis

Background and Aims: The rising incidence of chronic liver disease (CLD) has increased the need for early recognition. This systematic review assesses the diagnostic accuracy of the enhanced liver fibrosis (ELF) test in cases of advanced fibrosis and cirrhosis due to multiple etiologies in at-risk populations.

 Methods: Studies evaluating the ELF accuracy in identifying advanced fibrosis or cirrhosis, defined as METAVIR stage F ≥ 3 and F = 4 or equivalent, in patients with non-alcoholic fatty liver disease (NAFLD), alcohol liver disease (ALD), or viral hepatitis were included. Liver biopsy was used as the reference standard. Medline and Embase databases were searched. The QUADAS-2 tool was used as a framework to assess risk of bias and applicability. The area under the receiver operator curve (AUROC) was extracted as a summary measure of diagnostic accuracy. 

Results: Thirty-six studies were included: 11 hepatitis C, 4 hepatitis B, 9 NAFLD, 2 ALD, and 10 mixed. The ELF test showed good diagnostic performance in detecting advanced fibrosis in patients with viral hepatitis (AUROC 0.69 to 0.98) and excellent performance in NAFLD (AUROC 0.78 to 0.97) and ALD (AUROC from 0.92 to 0.94). There is also evidence of good diagnostic performance for detecting cirrhosis in patients with viral hepatitis (AUROC 0.63 to 0.99), good performance in NAFLD (AUROC 0.85 to 0.92), and excellent performance in patients with ALD (AUROC 0.93 to 0.94). 

Conclusion: This systematic review supports the use of the ELF test across a range of CLD as a possible alternative to liver biopsy in selected cases.

Diagnostic accuracy, enhanced liver fibrosis test, liver biopsy, liver fibrosis
0815-9319
1788-1802
Sharma, Chetanya
285ba42a-7e35-45b9-8f77-04a5f95108bc
Cococcia, Sara
9fabfb35-bc2e-4caf-a007-e0f6b11def45
Ellis, Nicola
bae0850e-efc5-4a5a-a975-eb68411b3b97
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Rosenberg, William
145ebec3-ffb6-45e7-8711-aa520ed42f55
Sharma, Chetanya
285ba42a-7e35-45b9-8f77-04a5f95108bc
Cococcia, Sara
9fabfb35-bc2e-4caf-a007-e0f6b11def45
Ellis, Nicola
bae0850e-efc5-4a5a-a975-eb68411b3b97
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Rosenberg, William
145ebec3-ffb6-45e7-8711-aa520ed42f55

Sharma, Chetanya, Cococcia, Sara, Ellis, Nicola, Parkes, Julie and Rosenberg, William (2021) Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis. Journal of Gastroenterology and Hepatology (Australia), 36 (7), 1788-1802. (doi:10.1111/jgh.15482).

Record type: Article

Abstract

Background and Aims: The rising incidence of chronic liver disease (CLD) has increased the need for early recognition. This systematic review assesses the diagnostic accuracy of the enhanced liver fibrosis (ELF) test in cases of advanced fibrosis and cirrhosis due to multiple etiologies in at-risk populations.

 Methods: Studies evaluating the ELF accuracy in identifying advanced fibrosis or cirrhosis, defined as METAVIR stage F ≥ 3 and F = 4 or equivalent, in patients with non-alcoholic fatty liver disease (NAFLD), alcohol liver disease (ALD), or viral hepatitis were included. Liver biopsy was used as the reference standard. Medline and Embase databases were searched. The QUADAS-2 tool was used as a framework to assess risk of bias and applicability. The area under the receiver operator curve (AUROC) was extracted as a summary measure of diagnostic accuracy. 

Results: Thirty-six studies were included: 11 hepatitis C, 4 hepatitis B, 9 NAFLD, 2 ALD, and 10 mixed. The ELF test showed good diagnostic performance in detecting advanced fibrosis in patients with viral hepatitis (AUROC 0.69 to 0.98) and excellent performance in NAFLD (AUROC 0.78 to 0.97) and ALD (AUROC from 0.92 to 0.94). There is also evidence of good diagnostic performance for detecting cirrhosis in patients with viral hepatitis (AUROC 0.63 to 0.99), good performance in NAFLD (AUROC 0.85 to 0.92), and excellent performance in patients with ALD (AUROC 0.93 to 0.94). 

Conclusion: This systematic review supports the use of the ELF test across a range of CLD as a possible alternative to liver biopsy in selected cases.

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More information

Accepted/In Press date: 22 February 2021
e-pub ahead of print date: 5 March 2021
Published date: 5 March 2021
Keywords: Diagnostic accuracy, enhanced liver fibrosis test, liver biopsy, liver fibrosis

Identifiers

Local EPrints ID: 448936
URI: http://eprints.soton.ac.uk/id/eprint/448936
ISSN: 0815-9319
PURE UUID: e80f9307-64f2-4714-b25a-04b8985f13fe
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X

Catalogue record

Date deposited: 11 May 2021 16:49
Last modified: 28 Apr 2022 01:44

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Contributors

Author: Chetanya Sharma
Author: Sara Cococcia
Author: Nicola Ellis
Author: Julie Parkes ORCID iD
Author: William Rosenberg

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