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Accuracy of the Enhanced Liver Fibrosis test, and combination of the Enhanced Liver Fibrosis and non‐invasive tests for the diagnosis of advanced liver fibrosis in patients with non‐alcoholic fatty liver disease
Author(s) -
Inadomi Chika,
Takahashi Hirokazu,
Ogawa Yuji,
Oeda Satoshi,
Imajo Kento,
Kubotsu Yoshihito,
Tanaka Kenichi,
Kessoku Takaomi,
Okada Michiaki,
Isoda Hiroshi,
Akiyama Takumi,
Fukushima Hideaki,
Yoneda Masato,
Anzai Keizo,
Aishima Shinichi,
Nakajima Atsushi,
Eguchi Yuichiro
Publication year - 2020
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13495
Subject(s) - receiver operating characteristic , fatty liver , medicine , liver biopsy , fibrosis , gastroenterology , liver disease , alcoholic liver disease , liver fibrosis , area under the curve , biopsy , cirrhosis , pathology , disease
Aim The Enhanced Liver Fibrosis (ELF) test comprises a logarithmic algorithm combining three serum markers of hepatic extracellular matrix metabolism. We aimed to evaluate the performance of ELF for the diagnosis of liver fibrosis and to compare it with that of liver stiffness measurement (LSM) by FibroScan in non‐alcoholic fatty liver disease. Methods ELF cut‐off values for the diagnosis of advanced fibrosis were obtained using receiver operating characteristic analysis in patients with biopsy‐confirmed non‐alcoholic fatty liver disease (training set; n = 200). Diagnostic performance was analyzed in the training set and in a validation set ( n = 166), and compared with that of LSM in the FibroScan cohort ( n = 224). Results The area under receiver operating characteristic curve was 0.81 for the diagnosis of advanced fibrosis, and the ELF cut‐off values were 9.34 with 90.4% sensitivity and 10.83 with 90.6% specificity in the training set, and 89.8% sensitivity and 85.5% specificity in the validation set. There was no significant difference in the area under the receiver operating characteristic curve between ELF and LSM (0.812 and 0.839). A combination of ELF (cut‐off 10.83) and LSM (cut‐off 11.45) increased the specificity to 97.9% and the positive predictive value, versus ELF alone. Sequential use of the Fibrosis‐4 index (cut‐off 2.67) and ELF (cut‐off 9.34) increased the sensitivity to 95.9%. Conclusions ELF can identify advanced liver fibrosis in non‐alcoholic fatty liver disease, and its diagnostic accuracy is comparable to that of FibroScan. According to the clinical setting, combinations or sequential procedures using other non‐invasive tests complement the diagnostic performance of ELF for the identification of advanced fibrosis.