Enhanced Liver Fibrosis Score Can Be Used to Predict Liver-Related Events in Patients With Nonalcoholic Steatohepatitis and Compensated Cirrhosis

Abstract

There is a growing need for a noninvasive tool to identify patients at higher risk of hepatic decompensation among individuals with compensated nonalcoholic steatohepatitis (NASH) cirrhosis.1 Hepatic venous pressure gradient (HVPG) has value in risk stratification2 and prediction of mortality among cirrhotics3 but has limitations of being invasive, costly, and a requirement for expertise.4 The Enhanced Liver Fibrosis (ELF) score is based on circulating markers of hepatic matrix turnover and consists of hyaluronic acid, TIMP-1 (tissue inhibitor of metalloproteinases-1), and PIIINP (propeptide of type III collagen). It identifies nonalcoholic fatty liver disease (NAFLD) patients with advanced fibrosis quite reliably.5,6 However, its utility as a prognostic biomarker among individuals with compensated cirrhosis due to NASH is unclear. This study evaluated the prognostic significance of the ELF score for predicting short-term liver-related outcomes among patients with compensated NASH cirrhosis.