TY  - JOUR
TI  - The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study
AV  - public
VL  - 21
Y1  - 2021/06/28/
IS  - 1
N1  - Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
N2  - BACKGROUND: 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, 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. METHODS: Observational 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. RESULTS: ELF 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). CONCLUSIONS: ELF 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.
ID  - discovery10130740
UR  - http://dx.doi.org/10.1186/s12876-021-01795-5
JF  - BMC Gastroenterology
A1  - Connoley, D
A1  - Patel, PJ
A1  - Hogan, B
A1  - Tanwar, S
A1  - Rhodes, F
A1  - Parkes, J
A1  - Burt, A
A1  - Watkins, J
A1  - Sievert, W
A1  - Rosenberg, W
KW  - Alcohol-related liver disease
KW  -  Cirrhosis
KW  -  Diagnosis
KW  -  Liver fibrosis
KW  -  Non-invasive testing
KW  -  Prognosis
KW  -  Serum biomarker panel
KW  -  Biomarkers
KW  -  Biopsy
KW  -  Cohort Studies
KW  -  Humans
KW  -  Liver
KW  -  Liver Cirrhosis
KW  -  Liver Diseases
KW  -  Liver Function Tests
KW  -  Prognosis
ER  -