732 ENHANCED LIVER FIBROSIS (ELF) SCORE IS RELATED TO LIVER DYSFUNCTION AND PREDICTS MORTALITY IN CIRRHOSIS

Abstract

Background: The Enhanced liver fibrosis (ELF) test is a noninvasive fibrosis panel composed of hyaluronic acid (HA), procollagen-3 N-terminal peptide (P3NP), and tissue inhibitor of metalloproteinase-1 (TIMP1). Previous studies have established high diagnostic accuracy of the ELF score to assess hepatic fibrosis and to predict liver-related clinical outcomes in chronic viral hepatitis and fatty liver disease. Aim of the present study was to relate baseline ELF scores to mortality in a cohort of cirrhotic patients. Methods: We enrolled 63 consecutive cirrhotic patients admitted to our outpatient liver clinic (29% females; age: 58±10 years; etiology alcohol in 64%). Serum samples obtained at baseline were used to perform ELF test (Siemens Health Care, Vienna, Austria). The prognostic value of ELF score, Child–Pugh (CP) score and model for end-stage liver disease (MELD) obtained at baseline was assessed by receiver operating characteristic (ROC) analysis. Logistic regression analysis with backward elimination of variables was used to determine independent prognostic variables. Results: Baseline characteristics of our study cohort were: CP-A 38%, CP-B 43%, CP-C 19%, CPS 7 (6, 9), MELD 13 (10, 16). ELF score increased progressively with the stage of cirrhosis as estimated by CP stage (CP-A: 10.8±1.0; CP-B: 12.2±1.0; CP-C: 13.2±1.3). During a median follow-up of 43 months, 27 patients developed hepatic decompensation, 18 patients died and 5 patients unterwent liver transplantation (LT). ROC analysis of baseline variables revealed superior diagnostic accuracy of ELF score compared to CP score and MELD for prediction of a combined endpoint death/LT at 1 year (AUC: ELF 0.80, CP score 0.71, MELD 0.71). On logistic regression analysis, ELF score remained the only significant prognostic variable for the combined endpoint death/LT at 1 year. Conclusion: Our results suggest that ELF score, a noninvasive marker of hepatic fibrosis, is related to severity of liver dysfunction and to mortality in cirrhosis and may represent a novel prognostic marker in chronic liver failure.