Biopsy-controlled liver fibrosis staging using the enhanced liver fibrosis (ELF) score compared to transient elastography

PLoS One. 2012;7(12):e51906. doi: 10.1371/journal.pone.0051906. Epub 2012 Dec 19.


Background and aims: Chronic liver diseases are characterized by inflammatory and fibrotic liver injuries that often result in liver cirrhosis with its associated complications such as portal hypertension and hepatocellular carcinoma. Liver biopsy still represents the reference standard for fibrosis staging, although transient elastography is increasingly used for non-invasive monitoring of fibrosis progression. However, this method is not generally available and is associated with technical limitations emphasizing the need for serological biomarkers staging of liver fibrosis. The enhanced liver fibrosis (ELF) score was shown to accurately predict significant liver fibrosis in different liver diseases, although extracellular matrix components detected by this score may not only mirror the extent of liver fibrosis but also inflammatory processes.

Methods: In this prospective biopsy-controlled study we evaluated the utility of the ELF score in comparison to transient elastography to predict different stages of fibrosis in 102 patients with chronic liver diseases.

Results: Both techniques revealed similar area under receiver operating characteristic curve values for prediction of advanced fibrosis stages. Compared to transient elastography, the ELF score showed a broader overlap between low and moderate fibrosis stages and a stronger correlation with inflammatory liver injury.

Conclusions: Both the ELF score as well as transient elastography allowed for high quality fibrosis staging. However, the ELF score was less discriminative in low and moderate fibrosis stages and appeared more strongly influenced by inflammatory liver injury. This should be considered when making clinical interpretations on the basis of ELF score values.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Disease Progression
  • Elasticity Imaging Techniques
  • Female
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / pathology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis

Grants and funding

This study was supported by the Deutsche Forschungsgemeinschaft (SFB Transregio 77, SFB 685, BA 2092/9-1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.