Z Gastroenterol 2013; 51 - A61
DOI: 10.1055/s-0033-1347436

Enhanced Liver Fibrosis (ELF) score is related to liver dysfunction and predicts mortality in cirrhosis

RE Stauber 1, W Spindelböck 1, C Putz-Bankuti 2, H Pock 1, T Stojakovic 1, B Obermayer-Pietsch 1
  • 1Medical University of Graz, Graz, Austria
  • 2LKH Hörgas, Gratwein, Austria

Background: The Enhanced liver fibrosis (ELF) test is a noninvasive fibrosis panel composed of hyaluronic acid (HA), procollagen-3 N-terminal peptide (P3NP), and tissue inhibitor of metalloproteinase-1 (TIMP1). Previous studies have established high diagnostic accuracy of the ELF score to assess hepatic fibrosis and to predict liver-related clinical outcomes in chronic viral hepatitis and fatty liver disease. Aim of the present study was to relate baseline ELF scores to mortality in a cohort of cirrhotic patients.

Methods: We enrolled 63 consecutive cirrhotic patients admitted to our outpatient liver clinic (29% females; age: 58 ± 10 years; etiology alcohol in 64%). Serum samples obtained at baseline were used to perform ELF test (Siemens Health Care, Vienna, Austria). The prognostic value of ELF score, Child-Pugh (CP) score and model for end-stage liver disease (MELD) obtained at baseline was assessed by receiver operating characteristic (ROC) analysis.

Results: Baseline characteristics of our study cohort were: CP-A 38%, CP-B 43%, CP-C 19%, median CP score 7 (6, 9), median MELD 13 (10, 16). ELF score increased progressively with the stage of cirrhosis as estimated by CP stage (CP-A: 10.8 ± 1.0; CP-B: 12.2 ± 1.0; CP-C: 13.2 ± 1.3). During a median follow-up of 43 months, 27 patients developed hepatic decompensation, 18 patients died and 5 patients unterwent liver transplantation (LT). ROC analysis of baseline variables revealed superior diagnostic accuracy of ELF score compared to CP score and MELD for prediction of a combined endpoint death/LT at 1 year (AUC: ELF 0.80, CP score 0.71, MELD 0.71).

Conclusion: Our results suggest that ELF score, a noninvasive marker of hepatic fibrosis, is related to severity of liver dysfunction and to mortality in cirrhosis and may represent a novel prognostic marker in chronic liver failure.