1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea; Liver Cirrhosis Clinical Research Center, Seoul, Korea.
Backgrounds/Aims: Serum fibrosis markers such as Enhanced Liver Fibrosis (ELF) test, have been suggested as alternatives for liver biopsy (LB) in assessing liver fibrosis. We investigated the efficacy of ELF test in predicting development of liver-related events (LRE) in patients with chronic hepatitis B (CHB).
Methods: A total of 170 patients (103 men, 60.6%) with CHB who underwent LB and serological tests for determining ELF were enrolled. All patients were followed-up to monitor LRE development, defined as hepatic decompensation, hepatocellular carcinoma, and/or liver-related death.
Results: The mean age was 45.3 years. During follow-up period (median, 41 months), 39 (22.9%) patients experienced LRE. In patients with LRE, age, proportion of male gender, ELF test results, age-spleen-platelet ratio (ASPRI), liver stiffness (LS) value, and histological fibrosis stage were significantly higher than those in patients without LRE (all P<0.05). Areas under receiver-operating characteristic curves to predict LRE development were 0.808 for ELF test, 0.732 for LS value, 0.713 for histological fibrosis stages using Batts and Ludwig scoring system, and 0.687 for ASPRI. On multivariate analysis, along with age, ELF test was an independent predictor of LRE development (adjusted hazard ratio [HR] 1.438, P<0.001). When we applied a three-tier stratification of our study population using cut-off ELF values of 8.10 and 10.40, patients with low (P=0.002; adjusted HR 0.045, 95% confidence interval [CI] 0.006-0.330) and intermediate (P<0.001; adjusted HR 0.239, 95% CI 0.122-0.469) ELF range were found less likely to develop LRE compared to those with high ELF range.
Conclusion: ELF is useful in a non-invasive prediction of LRE development. TE showed statistically similar prognostic performance for LRE as ELF, but other non-invasive tests were inferior.