Abstract
Background : The Enhanced Liver Fibrosis (ELF) score combining serum hyaluronan, N-terminal peptide of type III procollagen and tissue inhibitor of metalloproteinase-1, was reported as relevant in predicting liver fibrosis in chronic liver disease and proposed as an alternative to liver biopsy.
Methods : We evaluated the ELF score in a cohort of chronic hepatitis C (CHC) patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using commercial reagents, different from those developed by the manufacturer of the Siemens ELF™ test.
Results : In 512 CHC, the ELF score, using ROC curves, showed good predictive performances for severe fibrosis [AUROC=0.82; 95% confidence interval (CI) 0.78–0.86]and for cirrhosis (AUROC=0.85; 95% CI 0.81–0.90), but slightly lower for significant fibrosis (AUROC=0.78; 95% CI 0.74–0.82). The Obuchowski measure (0.81) showed that the ELF score globally performed as a marker of liver fibrosis. The ELF score predicted significant fibrosis (cut-off=9.0) with a sensitivity of 0.86, a specificity of 0.62, a positive predictive value (PPV) of 0.80 and a negative predictive value (NPV) of 0.70. For extensive fibrosis (cut-off=9.33), sensitivity was 0.90, specificity was 0.63, PPV was 0.73 and NPV was 0.85. For cirrhosis (cut-off=9.35), sensitivity was 0.83, specificity was 0.75, PPV was 0.44 and NPV was 0.95.
Conclusions : This study confirms the ELF score performance as an index to predict liver fibrosis or cirrhosis in CHC. The ELF test, using validated reagents, could be added to the health authorities approved non-invasive tests in assessing fibrosis as surrogate to liver biopsy.
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The ANRS HC EP 23 Fibrostar Study Group
Sponsor:
French National Agency for Research on aids and viral hepatitis (ANRS), Paris.
Scientific Committee:
Coordinators: J.-P. Zarski, Grenoble; M. Vaubourdolle, Paris;
Hepatologists: J.-P. Bronowicki, Lille; P. Calès, Angers; A. Mallat, Créteil; P. Mathurin, Lille;
Pathologists: N. Sturm, Grenoble; E.S. Zafrani, Créteil;
Biologists: B. Poggi, Lyon; J. Guéchot, Paris; Methodologists and administrators: J.L. Bosson; A. Paris; ANRS: L. Allain, Paris.
Methodologists and administrators:
A. Bechet, J.-L. Bosson, A. Paris, A. Plages, S. Royannais, Centre Hospitalier Universitaire de Grenoble
Biologists:
R.-C. Boisson, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon
M.-C. Gelineau, B. Poggi, Hôtel Dieu, Hospices Civils de Lyon
J.-C. Renversez, C. Trocmé, Centre Hospitalier Universitaire de Grenoble
J. Guéchot, E. Lasnier, M. Vaubourdolle, Hôpital Saint-Antoine, AP-HP, Paris
H. Voitot, Hôpital Beaujon, AP-HP, Paris
A. Vassault, Hôpital Necker, AP-HP, Paris
A. Rosenthal-Allieri, Centre Hospitalier Universitaire de Nice
A. Lavoinne, F. Ziegler, Centre Hospitalier Universitaire de Rouen
M. Bartoli, C. Dorche, C. Lebrun, Centre Hospitalier de Chambéry
A. Myara, Growwupe Hospitalier Paris Saint-Joseph, Paris
F. Guerber, A. Pottier, Laboratoire Elibio-Groupe Oriade, Vizille, La Mure
Hepatologists:
V. Leroy, J.-P. Zarski, Centre Hospitalier Universitaire de Grenoble A. Poujol-Robert, R. Poupon, Hôpital Saint-Antoine, AP-HP, Paris A. Abergel, Centre Hospitalier Universitaire de Clermont-Ferrand J.P. Bronowicki, H ô pital de Brabois, Centre Hospitalier Universitaire de Nancy
S. Metivier, J.P. Vinel, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse
V. De Ledinghen, Hôpital Haut Levêque, Centre Hospitalier Universitaire de Bordeaux
O. Goria, Centre Hospitalier Universitaire de Rouen
M. Maynard-Muet, C. Trepo, Hôtel Dieu, Hospices Civils de Lyon Ph. Mathurin, Centre Hospitalier Universitaire de Lille
H. Danielou, D. Guyader, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes
O. Rogeaux, Centre Hospitalier de Chambéry
S. Pol, Ph. Sogni, Hôpital Cochin, AP-HP, Paris
A. Tran, Hôpital De l’Archet, Centre Hospitalier Universitaire de Nice
P. Calès, Centre Hospitalier Universitaire d’Angers
T. Asselah, P. Marcellin, Hôpital Beaujon, AP-HP, Clichy
M. Bourlière, V. Oulès, Hôpital Saint Joseph, Assistance Publique- Hôpitaux de Marseille
D. Larrey, Centre Hospitalier Universitaire de Montpellier
F. Habersetzer, Centre Hospitalier Universitaire de Strasbourg
M. Beaugrand, Hôpital Jean Verdier, AP-HP, Bondy
Pathologists:
N. Sturm, Centre Hospitalier Universitaire de Grenoble E.-S. Zafrani, Hôpital Henri Mondor, AP-HP, Créteil
©2012 by Walter de Gruyter Berlin Boston