Reinson, Tina, Patel, Janisha, Mathews, Mead, Fountain, Derek, Buchanan, Ryan M. and Byrne, Christopher D. (2023) Performance of the enhanced liver fibrosis score, comparison with vibration-controlled transient elastography data, and development of a simple algorithm to predict significant liver fibrosis in a community-based liver service: a retrospective evaluation. Journal of Clinical and Translational Hepatology, 11 (4), 800-808, [JCTH-D-22-00335R1]. (doi:10.14218/JCTH.2022.00335).
Abstract
Background and aims: liver fibrosis is a key risk factor for cirrhosis, hepatocellular carcinoma and end stage liver failure. The National Institute for Health and Care Excellence guidelines for assessment for advanced (≥F3) liver fibrosis in people with non-alcoholic fatty liver disease recommend the use of enhanced liver fibrosis (ELF) test, followed by vibration controlled transient elastography (VCTE). Performance of ELF at predicting significant (≥F2) fibrosis in real-world practice is uncertain.To assess the accuracy of ELF using VCTE; investigate the optimum ELF cut-off value to identify ≥F2 and ≥F3; and develop a simple algorithm, with and without ELF score, for detecting ≥F2.
Methods: retrospective evaluation of patients referred to a Community Liver Service for VCTE, Jan-Dec 2020. Assessment included: body mass index (BMI), diabetes status, alanine aminotransferase (ALT) levels, ELF score and biopsy-validated fibrosis stages according to VCTE.
Results: data from 273 patients were available. N=110 patients had diabetes. ELF showed fair performance for ≥F2 and ≥F3, area under the curve (AUC)=0.70, 95% confidence interval (CI) 0.64-0.76 and AUC=0.72, 95% CI 0.65-0.79 respectively. For ≥F2 Youden’s Index for ELF=9.85 and for ≥F3, ELF=9.95. Combining ALT, BMI and HbA1c (ALBA algorithm) to predict ≥F2 showed good performance (AUC=0.80, 95% CI 0.69-0.92), adding ALBA to ELF improved performance (AUC=0.82, 95% CI 0.77-0.88). Results were independently validated.
Conclusion: optimal ELF cut-off for ≥F2 is 9.85 and 9.95 for ≥F3. ALT, BMI and HbA1c (ALBA algorithm) can be used to stratify patients at risk of ≥F2. ELF performance is improved by adding ALBA.
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