ELF test for advanced liver fibrosis

Last reviewed 11/2022

Enhanced Liver Fibrosis (ELF) score

• is an extracellular matrix (ECM) marker set consisting of tissue inhibitor of metalloproteinases 1 (TIMP-1), amino-terminal propeptide of type III procollagen (PIIINP) and hyaluronic acid (HA) showing good correlations with fibrosis stages in chronic liver disease
  • the ELF score combines quantitative serum concentration measurements of three fibrosis markers (TIMP-1, PIIINP, and HA) to a single value
    
    
• NICE suggest that:
  • consider using the enhanced liver fibrosis (ELF) test in people who have been diagnosed with non-alcoholic fatty liver disease (NAFLD) to test for advanced liver fibrosis
    • do not use routine liver blood tests to assess for advanced liver fibrosis in people with NAFLD
      
      
    • diagnose people with advanced liver fibrosis if they have:
      • an ELF score of 10.51 or above
      • and NAFLD
        
        
    • refer adults and young people diagnosed with advanced liver fibrosis to a relevant specialist in hepatology
      
      
    • explain to people with an ELF score below 10.51 that:
      • they are unlikely to have advanced liver fibrosis
      • and reassessment for advanced liver fibrosis every 3 years for adults and every 2 years for children and young people is sufficient for regular monitoring
      • and no interim tests are needed
        
        
    • offer retesting for advanced liver fibrosis for people with an ELF score below 10.51:
      • every 3 years to adults
      • every 2 years to children and young people
        
        
    • consider using ELF for retesting people with advanced liver fibrosis

Notes:

• liver fibrogenesis represents the uniform response of the liver to toxic, infectious, or metabolic agents and is characterized by an increased synthesis and altered deposition of newly formed extracellular matrix (ECM) components

Reference:

• NICE (July 2016). Non-alcoholic fatty liver disease (NAFLD): assessment and management