Performance of the Enhanced Liver Fibrosis Test to Estimate Advanced Fibrosis Among Patients With Nonalcoholic Fatty Liver Disease

The most important surrogate for increased risk of adverse clinical outcomes among patients with nonalcoholic fatty liver disease (NAFLD) is the patient's stage of liver fibrosis. There is a significant barrier to risk-stratifying patients in clinical practice owing to the need for liver biopsy...

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Published in:	JAMA network open 2021-09, Vol.4 (9), p.e2123923-e2123923
Main Authors:	Younossi, Zobair M, Felix, Sean, Jeffers, Thomas, Younossi, Elena, Nader, Fatema, Pham, Huong, Afendy, Arian, Cable, Rebecca, Racila, Andrei, Younoszai, Zahra, Lam, Brian P, Golabi, Pegah, Henry, Linda, Stepanova, Maria
Format:	Article
Language:	eng
Subjects:	Biopsy Clinical medicine Cross-Sectional Studies Diabetes Elasticity Imaging Techniques Female Gastroenterology and Hepatology Humans Liver Cirrhosis - diagnosis Liver Cirrhosis - diagnostic imaging Liver Cirrhosis - pathology Liver diseases Liver Function Tests Male Middle Aged Non-alcoholic Fatty Liver Disease Online Only Original Investigation Predictive Value of Tests Retrospective Studies ROC Curve Sensitivity and Specificity
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Summary:	The most important surrogate for increased risk of adverse clinical outcomes among patients with nonalcoholic fatty liver disease (NAFLD) is the patient's stage of liver fibrosis. There is a significant barrier to risk-stratifying patients in clinical practice owing to the need for liver biopsy. To determine the performance of the enhanced liver fibrosis (ELF) test as a noninvasive test for assessment of liver fibrosis among patients with NAFLD. This retrospective cross-sectional study was conducted among patients recruited from a large, community-based hospital system's outpatient liver clinic from 2001 to 2020. Patients with NAFLD defined as steatosis greater than 5% without evidence of other liver disease or excessive alcohol use were included. Data were analyzed from August 2020 through February 2021. Enhanced liver fibrosis score was calculated. Advanced fibrosis was identified by liver biopsy or transient elastography. Among 829 patients with NAFLD, the mean (SD) age was 53.1 (14.0) years, there were 363 (43.8%) men, 294 patients (35.5%) had type 2 diabetes, and the mean (SD) fibrosis-4 (fib-4) score was 1.34 (0.97). There were 463 patients with liver biopsy, among whom 113 individuals (24.4%) had bridging fibrosis or cirrhosis; among 462 patients with transient elastography data, 79 individuals (17.1%) had liver stiffness results of 9.6 kPa or more (ie, advanced fibrosis). Patients with advanced fibrosis had statistically significantly increased mean (SD) ELF scores compared with patients without advanced fibrosis as determined by biopsy (10.1 [1.3] vs 8.6 [1.0]; P
ISSN:	2574-3805 2574-3805