title: ELF-test less accurately identifies liver cirrhosis diagnosed by liver stiffness measurement in non-Asian women with chronic hepatitis B.
abstract: BACKGROUND
  The enhanced liver fibrosis test (ELF-test) has been validated for several hepatic diseases. However, its performance in chronic hepatitis B virus (CHB) infected patients is uncertain.
  
  
  OBJECTIVE
  This study investigates the diagnostic value of the ELF test for cirrhosis identified by liver stiffness measurement (LSM) in non-Asian women with CHB.
  
  
  METHODS
  Women of non-Asian origin with perinatally acquired CHB infection, detected during pregnancy in the period 1990-2003, returned to our center between September 2011 and May 2012 for LSM and blood sampling to perform an ELF test and to calculate, APRI and FIB-4 scores. Fibrosis stages were classified by the METAVIR system.
  
  
  RESULTS
  A total of 119 women were included in this study with a median age of 43 years, all ALT levels being <2× ULN and all being HBeAg negative. The overall median LSM (IQR) stiffness and ELF test were 5.5kPa (4.0-6.8) and 8.4 (7.8-9.2) respectively. LSM and ELF test classified 14 (12%) and 19 (16%) patients with severe fibrosis to cirrhosis (≥F3, i.e. liver stiffness >8.1kPa), however in only 4 (3%) patients there was an agreement between LSM and ELF test. With LSM as reference, the area under receiver operating characteristic curve (AUROC) for detection of ≥F3 fibrosis was for ELF 0.65 (95% CI 0.51-0.80; p=0.06), APRI 0.66 (0.50-0.82; p=0.07) and FIB-4 0.66 (0.49-0.82; p=0.07).
  
  
  CONCLUSIONS
  The ELF test less accurately discriminates severe fibrosis or cirrhosis when compared to LSM in our cohort of non-Asian women with CHB.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, The Netherlands. Electronic address: s.harkisoen@umcutrecht.nl.
authors.forename: S
authors.initials: S
authors.lastname: Harkisoen
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Boland
authors.affiliation: Department of Infectious diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J A R
authors.initials: JA
authors.lastname: van den Hoek
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: van Erpecum
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, The Netherlands.
authors.forename: A I M
authors.initials: AI
authors.lastname: Hoepelman
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Arends
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008875:Middle Aged; D011247:Pregnancy
chemical_list: D015415:Biomarkers
keywords: ELF-test; Fibrosis; Hepatitis B; Liver stiffness