Abstract
Objectives: The ELF scores, a non-invasive serum marker for liver fibrosis, has primarily been utilized in Western countries as an alternative to liver biopsy. In this study, we assessed its diagnostic efficacy in Japanese patients by comparing it with other biomarkers.
Methods: We included 122 patients with chronic liver disease or cirrhosis who underwent liver biopsy. ELF scores, calculated for each fibrosis stage（F0-F4）based on the New Inuyama Classification, were compared with platelet count, aspartate aminotransferase-to-platelet ratio index（APRI）, fibrosis-4 index, Mac-2-binding protein glycan isomer（M2BPGi）levels, and autotaxin（ATX）levels.
Results: ELF scores exhibited the highest correlation with fibrosis stages determined by liver biopsy（ρ=0.741, P < 0.001）compared to other biomarkers. ELF scores increased with the development of fibrosis, and were higher in F1 than in F0（P=0.0062）and in F2 than in F1（P=0.0223）. The area under the curve（AUC）values for the ELF scores were 0.913, 0.890, 0.870, and 0.850 for ≥ F1, ≥ F2, ≥ F3, and ≥ F4, respectively. The AUC values
of ELF scores were comparable to those of M2BPGi levels across all stages, surpassing ATX levels for ≥ F1, and outperforming other markers for both ≥ F1 and F2 stages. ELF scores exhibited high specificity（94.44%）for ≥ F1. For ≥ F2, sensitivity was 83.82%, specificity 81.48%. Both ≥ F3 and ≥ F4 demonstrated high sensitivity （86.96% and 90.00%, respectively）.
Conclusions: The ELF score, which strongly correlated with liver fibrosis, is particularly useful for diagnosing mild and moderate chronic hepatitis in Japanese patients and has the potential to rule out advanced liver fibrosis.
