Enhanced Liver Fibrosis (ELF) test accurately identifies liver fibrosis in patients with chronic hepatitis C

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J Viral Hepat. 2010 Feb 23. [Epub ahead of print]Enhanced Liver Fibrosis (ELF)

test accurately identifies liver fibrosis in patients with chronic hepatitis

C.Parkes J, Guha IN, Roderick P, S, Cross R, Manos MM, Irving W, Zaitoun

A, Wheatley M, Ryder S, Rosenberg W.Public Health Sciences & Medical Statistics,

University of Southampton, Southampton, UK.Summary. Assessment of liver fibrosis

is important in determining prognosis and evaluating interventions. Due to

limitations of accuracy and patient hazard of liver biopsy, non-invasive methods

have been sought to provide information on liver fibrosis, including the

European liver fibrosis (ELF) test, shown to have good diagnostic accuracy for

the detection of moderate and severe fibrosis. Access to independent cohorts of

patients has provided an opportunity to explore if this test could be

simplified. This paper reports the simplification of the ELF test and its

ability to identity severity of liver fibrosis in external validation studies in

patients with chronic hepatitis C (CHC). Paired biopsy and serum samples from

347 naïve patients with CHC in three independent cohorts were analysed.

Diagnostic performance characteristics were derived (AUROC, sensitivity and

specificity, predictive values), and clinical utility modelling performed to

determine the proportion of biopsies that could have been avoided if ELF test

was used in this patient group. It was possible to simplify the original ELF

test without loss of performance and the new algorithm is reported. The

simplified ELF test was able to predict severe fibrosis [pooled AUROC of 0.85

(95% CI 0.81-0.89)] and using clinical utility modelling to predict severe

fibrosis (Ishak stages 4-6; METAVIR stages 3 and 4) 81% of biopsies could have

been avoided (65% correctly). Issues of spectrum effect in diagnostic test

evaluations are discussed. In chronic hepatitis C a simplified ELF test can

detect severe liver fibrosis with good accuracy.PMID: 20196799 [PubMed - as

supplied by publisher]