Saarinen Kustaa, Färkkilä Martti, Jula Antti, Erlund Iris, Vihervaara Terhi, Lundqvist Annamari, Åberg Fredrik
Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
University of Helsinki, Helsinki, Finland.
JHEP Rep. 2023 Apr 21;5(7):100765. doi: 10.1016/j.jhepr.2023.100765. eCollection 2023 Jul.
BACKGROUND & AIMS: The Enhanced Liver Fibrosis® (ELF) test exhibits good discriminative performance in detecting advanced liver fibrosis and in predicting liver-related outcomes in patients with specific liver diseases, but large population-based studies are missing. We analysed the predictive performance of the ELF test in a general population cohort.
Data were sourced from the Health 2000 study, a Finnish population-based health examination survey conducted in 2000-2001. Subjects with baseline liver disease were excluded. The ELF test was performed on blood samples collected at baseline. Data were linked with national healthcare registers for liver-related outcomes (hospitalisation, cancer, and death).
The cohort comprised 6,040 individuals (mean age 52.7. 45.6% men) with 67 liver-related outcomes during a median 13.1-year follow-up. ELF predicted liver outcomes (unadjusted hazards ratio 2.70, 95% CI 2.16-3.38). with 5- and 10-year AUCs of 0.81 (95% CI 0.71-0.91) and 0.71 (95% CI 0.63-0.79) by competing-risk methodology. The 10-year risks for liver outcomes increased from 0.5% at ELF <9.8 to 7.1% at ELF ≥11.3, being higher among men than women at any given ELF level. Among individuals with body mass index ≥30 kg/m, diabetes, or alanine aminotransferase >40 U/L. Five-year AUCs for ELF were 0.85, 0.87, and 0.88, respectively. The predictive ability of the ELF test decreased with time: the 10-year AUCs were 0.78, 0.69, and 0.82, respectively.
The ELF test shows good discriminative performance in predicting liver-related outcomes in a large general population cohort and appears particularly useful for predicting 5-year outcomes in persons with risk factors.
The Enhanced Liver Fibrosis test exhibits good performance for predicting liver-related outcomes (hospitalisation, liver cancer, or liver-related death) in the general population, especially in those with risk factors.
增强肝纤维化（ELF）检测在检测晚期肝纤维化以及预测特定肝病患者的肝脏相关结局方面表现出良好的鉴别性能，但缺乏基于大规模人群的研究。我们分析了ELF检测在一般人群队列中的预测性能。
数据来源于2000 - 2001年进行的芬兰基于人群的健康检查调查“健康2000研究”。排除有基线肝病的受试者。对基线时采集的血样进行ELF检测。数据与国家医疗保健登记处的肝脏相关结局（住院、癌症和死亡）相关联。
该队列包括6040名个体（平均年龄52.7岁，45.6%为男性），在中位13.1年的随访期间有67例肝脏相关结局。ELF可预测肝脏结局（未调整风险比2.70，95%置信区间2.16 - 3.38），采用竞争风险方法得出的5年和10年曲线下面积（AUC）分别为0.81（95%置信区间0.71 - 0.91）和0.71（95%置信区间0.63 - 0.79）。肝脏结局的10年风险从ELF＜9.8时的0.5%增加到ELF≥11.3时的7.1%，在任何给定的ELF水平下，男性的风险均高于女性。在体重指数≥30 kg/m²、患有糖尿病或丙氨酸氨基转移酶＞40 U/L的个体中，ELF的5年AUC分别为0.85、0.87和0.88。ELF检测的预测能力随时间下降：10年AUC分别为0.78、0.69和0.82。
ELF检测在预测大型一般人群队列中的肝脏相关结局方面表现出良好的鉴别性能，对于预测有风险因素者的5年结局似乎特别有用。
增强肝纤维化检测在预测一般人群，尤其是有风险因素者的肝脏相关结局（住院、肝癌或肝脏相关死亡）方面表现良好。
