Abstract
BackgroundAlcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.MethodsObservational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality.ResultsELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823–0.968) and 0.923 (95% CI 0.866–0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908–0.960); non-alcohol = 0.907 (95% CI 0.895–0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55–4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39–2.99, p < 0.001).ConclusionsELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease.
Highlights
Alcohol is the main cause of chronic liver disease
Baseline characteristics Paired histology and Enhanced Liver Fibrosis (ELF) scores were available for 786 patients who met inclusion criteria, 81 with ARLD (Cohort-A) and 705 with chronic liver disease (CLD) due to other aetiologies (Cohort-NA)
In this study of 81 ARLD patients ELF was non-inferior compared to Liver biopsy (LB) in the identification of advanced fibrosis and cirrhosis, and in determining prognosis in ARLD compared to aetiologies other than alcohol [13, 26, 27]
Summary
Alcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease. Connoley et al BMC Gastroenterol (2021) 21:268 liver disease (ARLD) mortality with alcohol as the cause of half all cirrhosis-related deaths [1,2,3,4]. Abstinence is beneficial in all stages of ARLD and may lead to reversal of early fibrotic changes [6] and even in advanced cirrhosis surveillance for the detection and treatment of complications is recommended. Liver biopsy (LB) is the reference standard for fibrosis assessment, but diagnostic accuracy is influenced by sampling error and observer interpretation and it is associated with rare but significant complications [7,8,9,10].
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call