Enhanced liver fibrosis (ELF) score predicts hepatic decompensation and mortality

Background each unit change was associated with increased decompensation (adjusted Hazard Ratio (aHR) 2.215, 95% CI 1.934 – 2.537) and liver-related mortality (aHR 2.024, 95% CI 1.674 - 2.446). ELF outperformed FIB-4 for risk of liver-related mortality, particularly in the short-term (area under the curve (AUC) 94.3% vs 82.8% at six months). Where FIB-4 was indeterminate, ELF had higher AUC for all outcomes within at least two years. ELF ≥13 is associated with particularly high rates of decompensation (26% within 90 days) and all-cause mortality (38% at one year).ConclusionsThe addition of ELF has safely reduced the number of individuals referred for fibrosis assessment from the iLFT pathway and provides useful prognostic information. Individuals with ELF ≥13 are at high risk of negative outcomes and warrant urgent clinic assessment.Impact and implicationsPrimary care pathways for suspected liver disease are increasingly common and often lead to increased specialist hepatology referrals for fibrosis assessment. This study – using clinical follow-up for liver-related outcomes – adds to the evidence that ELF can safely reduce referrals in a two-step approach with other simple fibrosis markers. Additionally, ELF predicts liver-related morbidity and mortality, with ELF ≥13 an indicator of particularly high risk. This study may help inform the implementation of diagnostic pathways for early detection of liver disease and indicates the need for urgent review of individuals with very high ELF scores.