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Enhanced Liver Fibrosis (ELF) test can predict clinical outcomes in patients with chronic liver disease

Enhanced Liver Fibrosis (ELF) test can predict clinical outcomes in patients with chronic liver disease
Enhanced Liver Fibrosis (ELF) test can predict clinical outcomes in patients with chronic liver disease
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.
enhanced liver fibrosis panel, hepatitis C, liver fibrosis, serum marker panel
0017-5749
1245-1251
Parkes, J.
59dc6de3-4018-415e-bb99-13552f97e984
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Harris, S.
19ea097b-df15-4f0f-be19-8ac42c190028
Day, C
b9e6fd20-0bfb-42a5-bf63-23c996e0652d
Mutimer, D
9c6f893c-e2e4-483f-9961-6828a91eb509
Collier, J.
873e3575-f1c9-47a9-bd3c-71e05574767a
Lombard, M.
15f06022-c8ea-4e3a-9843-2b42f93de39b
Alexander, G.
a6e5b2a7-e06b-4149-8ad2-488c86cc5b2c
Ramage, J.
c49492ca-4c30-431a-b6fc-c67c97c51175
Dusheiko, G.
7a925717-4e4d-40ce-820e-242853efc432
Wheatley, M.
5a9546da-5ee6-432d-ab47-66427525322f
Gough, C
ec6f3e1e-9beb-4127-b17c-aefa299fcc6c
Burt, A
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Rosenberg, W.
1a551f54-b4aa-42e0-a5e1-45c6a5232821
Parkes, J.
59dc6de3-4018-415e-bb99-13552f97e984
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Harris, S.
19ea097b-df15-4f0f-be19-8ac42c190028
Day, C
b9e6fd20-0bfb-42a5-bf63-23c996e0652d
Mutimer, D
9c6f893c-e2e4-483f-9961-6828a91eb509
Collier, J.
873e3575-f1c9-47a9-bd3c-71e05574767a
Lombard, M.
15f06022-c8ea-4e3a-9843-2b42f93de39b
Alexander, G.
a6e5b2a7-e06b-4149-8ad2-488c86cc5b2c
Ramage, J.
c49492ca-4c30-431a-b6fc-c67c97c51175
Dusheiko, G.
7a925717-4e4d-40ce-820e-242853efc432
Wheatley, M.
5a9546da-5ee6-432d-ab47-66427525322f
Gough, C
ec6f3e1e-9beb-4127-b17c-aefa299fcc6c
Burt, A
0d979838-f711-428f-bc42-d11e662111cb
Rosenberg, W.
1a551f54-b4aa-42e0-a5e1-45c6a5232821

Parkes, J., Roderick, P., Harris, S., Day, C, Mutimer, D, Collier, J., Lombard, M., Alexander, G., Ramage, J., Dusheiko, G., Wheatley, M., Gough, C, Burt, A and Rosenberg, W. (2010) Enhanced Liver Fibrosis (ELF) test can predict clinical outcomes in patients with chronic liver disease. Gut, 59 (9), 1245-1251. (doi:10.1136/gut.2009.203166).

Record type: Article

Abstract

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.

This record has no associated files available for download.

More information

Published date: September 2010
Keywords: enhanced liver fibrosis panel, hepatitis C, liver fibrosis, serum marker panel
Organisations: Community Clinical Sciences, Primary Care & Population Sciences

Identifiers

Local EPrints ID: 79887
URI: http://eprints.soton.ac.uk/id/eprint/79887
ISSN: 0017-5749
PURE UUID: 366e355c-11b4-4a03-9daa-6f72102218f2
ORCID for J. Parkes: ORCID iD orcid.org/0000-0002-6490-395X
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 22 Mar 2010
Last modified: 09 Jan 2022 02:57

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Contributors

Author: J. Parkes ORCID iD
Author: P. Roderick ORCID iD
Author: S. Harris
Author: C Day
Author: D Mutimer
Author: J. Collier
Author: M. Lombard
Author: G. Alexander
Author: J. Ramage
Author: G. Dusheiko
Author: M. Wheatley
Author: C Gough
Author: A Burt
Author: W. Rosenberg

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