Enhanced liver fibrosis score as a surrogate of liver-related complications and mortality in primary biliary cholangitis

Abstract

The presence of bridging fibrosis predicts survival of primary biliary cholangitis (PBC). This study aimed to compare serum parameters for the estimation of liver fibrosis and prediction of clinical outcomes in PBC. Out of 392 patients with PBC, 102 who underwent liver biopsy and in whom fibrosis indices, platelet count, hyaluronic acid, type IV collagen 7 second domain, procollagen type III amino-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, N-terminal type III collagen propeptide levels; fibrosis index based on 4 factors, aspartate aminotransferase-to-platelet ratio index, and enhanced liver fibrosis (ELF) score were determined, were included. The correlation of histological stages based on both Scheuer and Nakanuma classifications with fibrosis indices was investigated. The Nakanuma system comprises grading for liver fibrosis and bile duct loss. Diagnostic performances of 10 fibrosis indices were evaluated to identify patients with poor prognosis. Moreover, correlations of those with PBC clinical manifestation and survival were also investigated. Enhances liver fibrosis (ELF) score had the highest correlation coefficient for liver fibrosis evaluated according to either the Scheuer or Nakanuma classification among 10 serum fibrosis indices. It also had the highest diagnostic performance in estimating Scheuer stage III and Nakanuma fibrosis score 2, both of which represent portal-bridging fibrosis. Patients with an ELF score of ≥10.0 had shorter survival and presented more frequently clinical complications than those with an ELF score of <10.0. ELF score determines the severity of liver fibrosis and predicts the occurrence of complications and survival in patients with PBC.

Noninvasive evaluation of fibrosis in adult biliary diseases

“…In this study, ELF test was associated with progression of fibrosis stage at any time point where it was measured, in contrast to ALP. Confirming the association of ELF with fibrosis, in PBC, ELF showed high correlation with histological liver fibrosis, whether this was assessed by the Scheuer or Nakanuma score, in a study of 102 Japanese patients with histologically confirmed PBC [16]. Taken together, current literature strongly supports ELF test as a reliable marker of fibrosis in PSC.…”

Meta‐analysis: Enhanced liver fibrosis test to identify hepatic fibrosis in chronic liver diseases

“…Repeat search of both databases on 05/07/2021 returned 31 new articles, none of which were suitable for inclusion. A further repeat search of both databases on 09/11/2021 returned a total of 29 new articles, two of which were suitable for inclusion 93,94 . In total, 63 papers 11,12,27,30,35–91,93,94 were included in the final analysis.…”

“…A further repeat search of both databases on 09/11/2021 returned a total of 29 new articles, two of which were suitable for inclusion 93,94 . In total, 63 papers 11,12,27,30,35–91,93,94 were included in the final analysis. A summary of the second search strategy including the reasons for exclusion is provided below (Figure 1A,B).…”

“…For the 14 CLD cohorts, six (42.9%) used Ishak, three (21.4%) used METAVIR, two (14.3%) used Scheuer, one (7.1%) used NASH CRN, one used a mixture of METAVIR and Batts‐Ludwig and one used a mixture of NASH CRN and METAVIR as the basis of their histological staging system. One study of patients with Autoimmune Hepatitis 85 used METAVIR for fibrosis staging and one study of patients with PBC 94 used Scheuer 100 . For the purposes of our analysis, these data were included with the other mixed CLD cohorts.…”

Application of the Latest Advances in Evidence-Based Medicine in Primary Biliary Cholangitis

“…Another study from Japan reported that an ELF score >10.0 was predictive of clinical outcomes and hepatic decompensation in patients with PBC. However, additional studies are needed to endorse its use as a sole NIT in PBC ( 22 ). Blood-based NIT have not gained wide acceptance by physicians or regulatory agencies regarding staging liver disease ( 20 ).…”