title: Comparison of ELF, FibroTest and FibroScan for the non-invasive assessment of liver fibrosis.
abstract: BACKGROUND
  FibroTest (FT) is the most frequently used serum fibrosis marker and consists of an algorithm of five fibrosis markers (alfa2-macroglobulin, apolipoproteinA1, haptoglobin, GGT, bilirubin). The Enhanced Liver Fibrosis (ELF) test consists of an algorithm of three fibrosis markers (hyaluronic acid, amino-terminal propeptide-of-type-III-collagen, tissue-inhibitor of matrix-metaloproteinase-1). While a systematic review has shown comparable results for both individual markers, there has been no direct comparison of both markers.
  
  
  METHODS
  In the present study, the ELF-test was analyzed retrospectively in patients with chronic liver disease, who received a liver biopsy, transient elastography (TE) and the FibroTest using histology as the reference method. Histology was classified according to METAVIR and the Ludwig's classification (F0-F4) for patients with chronic hepatitis C and B virus (HCV, HBV) infection and primary biliary cirrhosis (PBC), respectively.
  
  
  RESULTS
  Seventy-four patients were analysed: 36 with HCV, 10 with HBV, and 28 with PBC. The accuracy (AUROC) for the diagnosis of significant fibrosis (F≥2) for ELF and FibroTest was 0.78 (95%CI:0.67-0.89) and 0.69 (95%-CI:0.57-0.82), respectively (difference not statistically significant, n.s.). The AUROC for the diagnosis of liver cirrhosis was 0.92 (95%CI:0.83-1,00), and 0.91 (95%CI:0.83-0.99), respectively (n.s.). For 66 patients with reliable TE measurements the AUROC for the diagnosis of significant fibrosis (cirrhosis) for TE, ELF and FT were 0.80 (0.94), 0.76 (0.92), and 0.67 (0.91), respectively (n.s.).
  
  
  CONCLUSIONS
  FibroTest and ELF can be performed with comparable diagnostic accuracy for the non-invasive staging of liver fibrosis. Serum tests are informative in a higher proportion of patients than transient elastography.
authors.affiliation: Department of Internal Medicine 1, JW Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Mireen
authors.initials: M
authors.lastname: Friedrich-Rust
authors.forename: William
authors.initials: W
authors.lastname: Rosenberg
authors.forename: Julie
authors.initials: J
authors.lastname: Parkes
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011347:Procollagen / Q000378:metabolism*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000378:metabolism*; D055815:Young Adult
chemical_list: D011347:Procollagen; D019715:Tissue Inhibitor of Metalloproteinase-1; D006820:Hyaluronic Acid