The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study.

Autor: Connoley D; Monash University, Melbourne, Australia.; Monash Health, Melbourne, Australia.; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.; The Royal Free London NHS Foundation Trust, London, UK., Patel PJ; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.; The Royal Free London NHS Foundation Trust, London, UK., Hogan B; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK., Tanwar S; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK., Rhodes F; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.; The Royal Free London NHS Foundation Trust, London, UK., Parkes J; Primary Care, Public Health and Medical Statistics, University of Southampton, Southampton, UK., Burt A; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia., Watkins J; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK., Sievert W; Monash University, Melbourne, Australia.; Monash Health, Melbourne, Australia., Rosenberg W; Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK. w.rosenberg@ucl.ac.uk.; The Royal Free London NHS Foundation Trust, London, UK. w.rosenberg@ucl.ac.uk.
Jazyk: angličtina
Zdroj: BMC gastroenterology [BMC Gastroenterol] 2021 Jun 28; Vol. 21 (1), pp. 268. Date of Electronic Publication: 2021 Jun 28.
DOI: 10.1186/s12876-021-01795-5
Abstrakt: Background: Alcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.
Methods: Observational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality.
Results: ELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823-0.968) and 0.923 (95% CI 0.866-0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908-0.960); non-alcohol = 0.907 (95% CI 0.895-0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55-4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39-2.99, p < 0.001).
Conclusions: ELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease.
Databáze: MEDLINE
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