Enhanced liver fibrosis test as a reliable tool for assessing fibrosis in nonalcoholic fatty liver disease in a clinical setting



Liver fibrosis is the main determinant and predictor of the clinical course of nonalcoholic fatty liver disease (NAFLD). To date, a liver biopsy is still considered the gold standard for staging fibrosis. The aim of this study was to investigate the diagnostic accuracy of the commercial enhanced liver fibrosis (ELF) test manufacturer’s cutoff value (≥9.8) in identifying severe fibrosis for adult patients with histologically confirmed NAFLD.


We tested the ELF test in a clinical practice, prospective cohort of 82 consecutive patients who consecutively underwent percutaneous liver biopsy.


All stages of liver fibrosis were represented in our cohort, and severe fibrosis was present in 15 of 82 patients (18.3%). The stage of fibrosis was significantly associated with ELF score (Spearman’s rho = 0.483, p<0.001). The commercial ELF test manufacturer’s cutoff identified severe fibrosis with good sensitivity (86.7%; 95% confidence interval [95% CI], 0.69-1.04) and high specificity (92.5%; 95% CI, 0.86-0.99), with a positive predictive value of 72% and negative predictive value of 97%.


Our data could support the use of the ELF test in clinical practice.

Int J Biol Markers 2017; 32(4): e397 - e402




Luca Miele, Teresa De Michele, Giuseppe Marrone, Maria Antonietta Isgrò, Umberto Basile, Consuelo Cefalo, Marco Biolato, Fabio Maria Vecchio, Gian Lodovico Rapaccini, Antonio Gasbarrini, Cecilia Zuppi, Antonio Grieco

Article History


Financial support: This study was supported by grants PRIN 2010-2011 (prot. no. 2010C4JJWB) (to A. Grieco) and Catholic University Linea D1 (to A. Grieco) and Linea D3 (to A. Gasbarrini and A. Grieco). Siemens Healthcare Diagnostics, Germany, provided the reagents for the ELF test (to C. Z.).
Conflict of interest: The authors declare that they have no competing interests.

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  • Department of Internal Medicine and Gastroenterology, Gemelli University Hospital, Catholic University of Sacred Heart, Rome - Italy
  • Department of Diagnostic Imaging and Laboratory Medicine, Gemelli University Hospital, Catholic University of Sacred Heart, Rome - Italy
  • Department of Pathology, Gemelli University Hospital, Catholic University of Sacred Heart, Rome - Italy

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