Leeds Liver Unit, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Leeds Liver Research Group, University of Leeds, Leeds, UK.
Aliment Pharmacol Ther. 2023 Apr;57(7):750-762. doi: 10.1111/apt.17385. Epub 2023 Jan 17.
BACKGROUND & AIMS: Patients with liver disease can be stratified for risk of liver-related ill health by degree of hepatic fibrosis. The Enhanced liver fibrosis (ELF) test was developed to quantify hepatic fibrosis non-invasively and is widely used. The objective of this review was to identify and synthesise the evidence on the diagnostic accuracy of the ELF test for staging of hepatic fibrosis.
APPROACH & RESULTS: Searches of PubMed and EMBASE were conducted between October 2020 and November 2021 to identify studies reporting the diagnostic accuracy of the ELF test compared to histology in liver disease patients. QUADAS-2 was used to assess risk of bias in each study. Meta-analysis using the multiple thresholds model described by Steinhauser S, Schumacher M, Rücker G. Modelling multiple thresholds in meta-analysis of diagnostic test accuracy studies. BMC Med. Res. Methodol. 2016;16. 10.1186/s12874-016-0196-1 allowed synthesis of 2 × 2 data at different cut-offs. Sixty-three studies were included in this review. These studies included 19,285 patients with or at risk of liver disease from viral hepatitis, Non-Alcoholic Fatty Liver Disease, Alcohol-related Liver Disease and other mixed chronic liver diseases. The prevalence of significant fibrosis, advanced fibrosis and cirrhosis was 47.5%, 39.2% and 4.4%, respectively. Cut-offs with maximal Youden index were generated with AUROC = 0.811 (95% CI: 0.736-0.870), 0.812 (95% CI: 0.758-0.856) and 0.810 (95% CI: 0.694-0.888) to detect significant fibrosis, advanced fibrosis or cirrhosis, respectively. Diagnostic accuracy of the ELF test varied between different liver diseases and cut-offs to detect each stage with 95% sensitivity or specificity were also generated.
Meta-analysis revealed considerable variability in the ability of ELF to stage fibrosis across disease aetiologies. Research has mostly focused on viral hepatitis and NAFLD. There is currently a lack of data on the value of the ELF test in Alcohol-related liver disease and patients in primary care settings.
通过肝纤维化程度，肝病患者可以进行与肝脏相关疾病风险的分层。Enhanced liver fibrosis（ELF）检测旨在无创量化肝纤维化，并得到广泛应用。本综述的目的是确定并综合评估 ELF 检测对肝纤维化分期的诊断准确性的证据。
2020 年 10 月至 2021 年 11 月，在 PubMed 和 EMBASE 中进行了检索，以确定报道 ELF 检测与肝病患者组织学比较的诊断准确性的研究。使用 QUADAS-2 评估每项研究的偏倚风险。使用 Steinhauser S、Schumacher M、Rücker G 描述的多阈值模型对来自不同阈值的 2×2 数据进行汇总。Meta 分析。Modeling multiple thresholds in meta-analysis of diagnostic test accuracy studies. BMC Med. Res. Methodol. 2016;16. 10.1186/s12874-016-0196-1 允许在不同截止值下汇总 2×2 数据。本综述纳入了 63 项研究。这些研究包括来自病毒性肝炎、非酒精性脂肪性肝病、酒精性肝病和其他混合慢性肝病的 19285 名患者或有肝病风险的患者。显著纤维化、晚期纤维化和肝硬化的患病率分别为 47.5%、39.2%和 4.4%。生成具有最大 Youden 指数的截止值，AUROC 分别为 0.811（95%CI：0.736-0.870）、0.812（95%CI：0.758-0.856）和 0.810（95%CI：0.694-0.888），以检测显著纤维化、晚期纤维化或肝硬化。ELF 检测诊断准确性在不同肝病和截止值之间存在差异，也生成了以 95%灵敏度或特异性检测每个阶段的截止值。
Meta 分析显示，ELF 分期纤维化的能力在不同病因的疾病中存在显著差异。研究主要集中在病毒性肝炎和非酒精性脂肪性肝病上。目前缺乏关于酒精性肝病和初级保健环境中患者的 ELF 检测价值的数据。
