Systematic review: Accuracy of the enhanced liver fibrosis test for diagnosing advanced liver fibrosis and cirrhosis.

Chetanya Sharma,Julie Parkes,Nicola Ellis,Sara Cococcia,William Rosenberg

doi:10.1111/jgh.15482

Abstract

The rising incidence of chronic liver disease (CLD) has increased the need for early recognition. This systematic review assesses the diagnostic accuracy of the enhanced liver fibrosis (ELF) test in cases of advanced fibrosis and cirrhosis due to multiple etiologies in at-risk populations. Studies evaluating the ELF accuracy in identifying advanced fibrosis or cirrhosis, defined as METAVIR stage F≥3 and F=4 or equivalent, in patients with non-alcoholic fatty liver disease (NAFLD), alcohol liver disease (ALD), or viral hepatitis were included. Liver biopsy was used as the reference standard. Medline and Embase databases were searched. The QUADAS-2 tool was used as a framework to assess risk of bias and applicability. The area under the receiver operator curve (AUROC) was extracted as a summary measure of diagnostic accuracy. Thirty-six studies were included: 11 hepatitis C, 4 hepatitis B, 9 NAFLD, 2 ALD, and 10 mixed. The ELF test showed good diagnostic performance in detecting advanced fibrosis in patients with viral hepatitis (AUROC 0.69 to 0.98) and excellent performance in NAFLD (AUROC 0.78 to 0.97) and ALD (AUROC from 0.92 to 0.94). There is also evidence of good diagnostic performance for detecting cirrhosis in patients with viral hepatitis (AUROC 0.63 to 0.99), good performance in NAFLD (AUROC 0.85 to 0.92), and excellent performance in patients with ALD (AUROC 0.93 to 0.94). This systematic review supports the use of the ELF test across a range of CLD as a possible alternative to liver biopsy in selected cases.

Highlights

Background and AimsThe rising incidence of chronic liver disease (CLD) has increased the need for early recognition
The inclusion criteria were as follows: primary research cross-sectional studies of diagnostic accuracy that had assessed liver fibrosis in adult participants with CLD caused by non-alcoholic fatty liver disease (NAFLD), alcohol liver disease (ALD) or hepatitis B virus (HBV) or hepatitis C virus (HCV); mixed etiology studies including patients from at least one of the above-mentioned disease etiologies; studies assessing the diagnostic accuracy of the enhanced liver fibrosis (ELF) test; single or two-gate/case–control designs; studies published in the English language
In patients infected with HCV, there is a good quantity of evidence showing fair to excellent performance of the ELF test in detecting advanced fibrosis with slightly better performance for detecting cirrhosis

Summary

Introduction

Background and AimsThe rising incidence of chronic liver disease (CLD) has increased the need for early recognition. This systematic review assesses the diagnostic accuracy of the enhanced liver fibrosis (ELF) test in cases of advanced fibrosis and cirrhosis due to multiple etiologies in at-risk populations. Methods: Studies evaluating the ELF accuracy in identifying advanced fibrosis or cirrhosis, defined as METAVIR stage F ≥ 3 and F = 4 or equivalent, in patients with non-alcoholic fatty liver disease (NAFLD), alcohol liver disease (ALD), or viral hepatitis were included. The ELF test showed good diagnostic performance in detecting advanced fibrosis in patients with viral hepatitis (AUROC 0.69 to 0.98) and excellent performance in NAFLD (AUROC 0.78 to 0.97) and ALD (AUROC from 0.92 to 0.94). There is evidence of good diagnostic performance for detecting cirrhosis in patients with viral hepatitis (AUROC 0.63 to 0.99), good performance in NAFLD (AUROC 0.85 to 0.92), and excellent performance in patients with ALD (AUROC 0.93 to 0.94). There is a need for tests to detect the presence of fibrosis before it causes irreversible damage, to stratify which patients might benefit from specialist care, and to target surveillance for complications.[2]

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Discussion

Conclusion