title: Prospective validation of ELF test in comparison with Fibroscan and FibroTest to predict liver fibrosis in Asian subjects with chronic hepatitis B.
abstract: OBJECTIVE
  Liver stiffness measurement (LSM) and FibroTest (FT) are frequently used as non-invasive alternatives for fibrosis staging to liver biopsy. However, to date, diagnostic performances of Enhanced Liver Fibrosis (ELF) test, which consists of hyaluronic acid, aminoterminal propeptide of procollagen type-III, and tissue inhibitor of matrix metalloproteinases-1, have not been compared to those of LSM and FT in Asian chronic hepatitis B (CHB) patients.
  
  
  METHODS
  Between June 2010 and November 2011, we prospectively enrolled 170 CHB patients who underwent liver biopsies along with LSM, FT, and ELF. The Batts system was used to assess fibrosis stages.
  
  
  RESULTS
  Areas under receiver operating characteristic curves (AUROCs) to predict significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F = 4) were 0.901, 0.860, and 0.862 for ELF, respectively; 0.937, 0.956, and 0.963 for LSM; and 0.896, 0.921, and 0.881 for FT. AUROCs to predict F≥2 were similar between each other, whereas LSM and FT had better AUROCs than ELF for predicting F≥3 (both p<0.05), and LSM predicted F4 more accurately than ELF (p<0.05). Optimized cutoffs of ELF to maximize sum of sensitivity and specificity were 8.5, 9.4, and 10.1 for F≥2, F≥3, and F = 4, respectively. Using suggested ELF, LSM and FT cutoffs to diagnose F1, F2, F3, and F4, 91 (53.5%), 117 (68.8%), and 110 (64.7%) patients, respectively, were correctly classified according to histological results.
  
  
  CONCLUSIONS
  ELF demonstrated considerable diagnostic value in fibrosis staging in Asian CHB patients, especially in predicting F≥2. However, LSM consistently provided better performance for predicting F≥3 and F4.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Beom Kyung
authors: BK
authors: Kim
authors: Hyon Suk
authors: HS
authors: Kim
authors: Jun Yong
authors: JY
authors: Park
authors: Do Young
authors: DY
authors: Kim
authors: Sang Hoon
authors: SH
authors: Ahn
authors: Chae Yoon
authors: CY
authors: Chon
authors: Young Nyun
authors: YN
authors: Park
authors: Kwang-Hyub
authors: KH
authors: Han
authors: Seung Up
authors: SU
authors: Kim
mesh_terms: D044466:Asian People; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies