The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study
The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study
Background: alcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.
Methods: observational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality.
Results: ELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823–0.968) and 0.923 (95% CI 0.866–0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908–0.960); non-alcohol = 0.907 (95% CI 0.895–0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55–4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39–2.99, p < 0.001).
Conclusions: ELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease.
Alcohol-related liver disease, Cirrhosis, Diagnosis, Liver fibrosis, Non-invasive testing, Prognosis, Serum biomarker panel
Connoley, Declan
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Patel, Preya Janubhai
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Hogan, Brian
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Tanwar, Sudeep
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Rhodes, Freya
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Parkes, Julie
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Burt, Alastair
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Watkins, Jennifer
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Sievert, William
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Rosenberg, William
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Connoley, Declan
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Patel, Preya Janubhai
93d22ac6-5fce-4fe3-a9aa-09131c569d40
Hogan, Brian
1659503a-5dfe-493a-b256-b784fedd4bf8
Tanwar, Sudeep
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Rhodes, Freya
a61f9b37-888f-45fe-aca9-345267afb3ed
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Burt, Alastair
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Watkins, Jennifer
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Sievert, William
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Rosenberg, William
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Connoley, Declan, Patel, Preya Janubhai, Hogan, Brian, Tanwar, Sudeep, Rhodes, Freya, Parkes, Julie, Burt, Alastair, Watkins, Jennifer, Sievert, William and Rosenberg, William
(2021)
The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study.
BMC Gastroenterology, 21 (1), [268].
(doi:10.1186/s12876-021-01795-5).
Abstract
Background: alcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.
Methods: observational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality.
Results: ELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823–0.968) and 0.923 (95% CI 0.866–0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908–0.960); non-alcohol = 0.907 (95% CI 0.895–0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55–4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39–2.99, p < 0.001).
Conclusions: ELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease.
Text
s12876-021-01795-5
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Accepted/In Press date: 20 April 2021
e-pub ahead of print date: 28 June 2021
Additional Information:
Funding Information:
The assays used for measuring the components of the Enhanced Liver Fibrosis test were provided without restrictions by Siemens Healthineers (Siemens Healthineers, Tarrytown, New York, USA). Siemens Healthineers had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. WMR is supported by the UCLH NIHR Biomedical Research Centre and is a NIHR Senior Investigator.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
Alcohol-related liver disease, Cirrhosis, Diagnosis, Liver fibrosis, Non-invasive testing, Prognosis, Serum biomarker panel
Identifiers
Local EPrints ID: 450401
URI: http://eprints.soton.ac.uk/id/eprint/450401
ISSN: 1471-230X
PURE UUID: ea4ad5fb-f379-4732-bf22-8a4cfbf64985
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Date deposited: 27 Jul 2021 17:23
Last modified: 18 Mar 2024 02:49
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Contributors
Author:
Declan Connoley
Author:
Preya Janubhai Patel
Author:
Brian Hogan
Author:
Sudeep Tanwar
Author:
Freya Rhodes
Author:
Alastair Burt
Author:
Jennifer Watkins
Author:
William Sievert
Author:
William Rosenberg
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