title: The performance of enhanced liver fibrosis (ELF) test for the staging of liver fibrosis: a meta-analysis.
abstract: BACKGROUND
  The enhanced liver fibrosis test (ELF) has been shown to accurately predict significant liver fibrosis in several liver diseases.
  
  
  OBJECTIVE
  To perform a meta-analysis to assess the performance of the ELF test for the assessment of liver fibrosis.
  
  
  METHODS
  Electronic and manual searches were performed to identify studies of the ELF test. After methodological quality assessment and data extraction, pooled estimates of the sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and summary receiver operating characteristics (sROC) were assessed systematically. The extent of heterogeneity and reasons for it were assessed.
  
  
  RESULTS
  Nine studies were identified for analysis. The pooled sensitivity, specificity, positive LR, negative LR, and DOR values of ELF test, for assessment of significant liver fibrosis, were 83% (95% CI=0.80-0.86), 73% (95% CI=0.69-0.77), 4.00 (95% CI=2.50-6.39), 0.24 (95% CI=0.17-0.34), and 16.10 (95% CI=8.27-31.34), respectively; and, for evaluation of severe liver fibrosis, were 78% (95% CI=0.74-0.81), 76% (95% CI=0.73-0.78), 4.39 (95% CI=2.76-6.97), 0.27 (95% CI=0.16-0.46), and 16.01 (95% CI: 7.15-35.82), respectively; and, for estimation of cirrhosis, were 80% (95% CI=0.75-0.85), 71% (95% CI=0.68-0.74), 3.13 (95% CI=2.01-4.87), 0.29 (95% CI=0.19-0.44), and 14.09 (95% CI: 5.43-36.59), respectively.
  
  
  CONCLUSIONS
  The ELF test shows good performance and considerable diagnostic value for the prediction of histological fibrosis stage.
authors.affiliation: Division of Hepatobilitary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi- Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China; Key laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Qingsong
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Division of Hepatobilitary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi- Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China; Key laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Xiaohu
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Division of Hepatobilitary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi- Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China; Key laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Huang
authors.affiliation: Division of Hepatobilitary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi- Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China; Key laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Wei
authors.affiliation: Division of Hepatobilitary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi- Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China; Key laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Weilin
authors.initials: W
authors.lastname: Wang
authors.affiliation: Division of Hepatobilitary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi- Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China; Key laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D001706:Biopsy; D054459:Elasticity Imaging Techniques; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology*; D016017:Odds Ratio; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
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