ELF Test
The ELF (Enhanced Liver Fibrosis) test is a non-invasive blood test for assessing stage of liver fibrosis and/or how likely it is to progress to cirrhosis in patients who have signs, symptoms or risk factors for chronic liver disease.
Using a simple blood sample, the test directly measures three serum biomarkers involved in liver tissue remodelling:
- hyaluronic acid (HA)
- procollagen type III N-terminal propeptide (PIIINP)
- tissue inhibitor of metalloproteinase-1 (TIMP-1)
Those values are then entered into an algorithm (equation) to produce an ELF score to classify the risk of developing fibrosis or progressing to cirrhosis.
The ELF test is used for identifying and classifying the risk of liver fibrosis earlier in patients who have a high risk of developing metabolic dysfunction-associated steatotic (fatty) liver disease (MASLD/MASH), especially patients with the following characteristics:
- Fatty liver found on medical imaging
- Body mass index (BMI) ≥ 30
- Type-2 diabetes
- Abnormal liver function test
Applying an algorithm that combines the ELF and FIB-4 tests provides significant improvement in the detection of fibrosis and reduces unnecessary referrals for specialized, more invasive care for these patients.
In practice, a low FIB-4 score (< 1.30) rules out any significant risk of fibrosis, while an intermediate (1.30–2.67) or high (> 2.67) score justifies further evaluation with the ELF test so the risk can be better classified.
The test is a valuable tool for managing patients with MASLD, a condition whose prevalence is significant and growing.