Enhanced liver Fibrosis® test predicts liver-related outcomes in the general population

Kustaa Saarinen; Martti Färkkilä; Antti Jula; Iris Erlund; Terhi Vihervaara; Annamari Lundqvist; Fredrik Åberg

doi:10.1016/j.jhepr.2023.100765

Enhanced liver Fibrosis® test predicts liver-related outcomes in the general population

JHEP Rep. 2023 Apr 21;5(7):100765. doi: 10.1016/j.jhepr.2023.100765. eCollection 2023 Jul.

Authors

Kustaa Saarinen¹, Martti Färkkilä^{1

2}, Antti Jula³, Iris Erlund³, Terhi Vihervaara³, Annamari Lundqvist³, Fredrik Åberg⁴

Affiliations

¹ Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
² University of Helsinki, Helsinki, Finland.
³ Finnish Institute for Health and Welfare, Helsinki, Finland.
⁴ Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.

Abstract

Background & aims: The Enhanced Liver Fibrosis® (ELF) test exhibits good discriminative performance in detecting advanced liver fibrosis and in predicting liver-related outcomes in patients with specific liver diseases, but large population-based studies are missing. We analysed the predictive performance of the ELF test in a general population cohort.

Methods: Data were sourced from the Health 2000 study, a Finnish population-based health examination survey conducted in 2000-2001. Subjects with baseline liver disease were excluded. The ELF test was performed on blood samples collected at baseline. Data were linked with national healthcare registers for liver-related outcomes (hospitalisation, cancer, and death).

Results: The cohort comprised 6,040 individuals (mean age 52.7. 45.6% men) with 67 liver-related outcomes during a median 13.1-year follow-up. ELF predicted liver outcomes (unadjusted hazards ratio 2.70, 95% CI 2.16-3.38). with 5- and 10-year AUCs of 0.81 (95% CI 0.71-0.91) and 0.71 (95% CI 0.63-0.79) by competing-risk methodology. The 10-year risks for liver outcomes increased from 0.5% at ELF <9.8 to 7.1% at ELF ≥11.3, being higher among men than women at any given ELF level. Among individuals with body mass index ≥30 kg/m², diabetes, or alanine aminotransferase >40 U/L. Five-year AUCs for ELF were 0.85, 0.87, and 0.88, respectively. The predictive ability of the ELF test decreased with time: the 10-year AUCs were 0.78, 0.69, and 0.82, respectively.

Conclusions: The ELF test shows good discriminative performance in predicting liver-related outcomes in a large general population cohort and appears particularly useful for predicting 5-year outcomes in persons with risk factors.

Impact and implications: The Enhanced Liver Fibrosis test exhibits good performance for predicting liver-related outcomes (hospitalisation, liver cancer, or liver-related death) in the general population, especially in those with risk factors.

Keywords: Cirrhosis; ELF test; General population; Liver fibrosis; Non-invasive liver fibrosis test; Prognosis.