Significance of Enhanced Liver Fibrosis test in liver-related outcomes in postmenopausal women 

Although chronic liver disease (CLD) is usually asymptomatic, earlier detection is precarious to allow life-saving interventions for those at risk due to high alcohol intake and increased body mass index (BMI). The goal of the present study was to assess the association between the Enhanced Liver Fibrosis (ELF) test and liver-related events (LRE) and its potential in predicting LRE in postmenopausal women with risk factors.

The present trial included a cohort of 95,126 women, among which ELF was measured in blinded samples from 173 participants with self-reported high alcohol use and / or BMI ≥25 kg/m2 along with all 58 cases who developed LRE and 115 controls who did not develop LRE during median follow-up of 8.5 years.

ELF threshold of 10.51 hazard ratios (HR) for LRE were 4.88 (unadjusted model) and 4.62 (adjusted for deprivation and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes), as assessed by the help of Cox regression. Moreover, at a threshold of 9.8 HR for LRE were 2.21 (unadjusted model) and 2.18 (adjusted). ELF was then measured as a time dependent variable by generating time-dependent Cox models; HRs at an ELF threshold of 10.51 were 1.94 (unadjusted) and 2.05 (adjusted) and at a threshold of 9.8 HRs were 1.85 (unadjusted) and 1.80 (adjusted). Area under the receiver operating characteristic curve for recruitment ELF predicting LRE was 0.58, and for second subsequent ELF 0.61.

Thus, the study showed evidence of an interrelationship between ELF and CLD in postmenopausal women with risk factors for liver disease such as increased BMI and high alcohol consumption. This association in turn, offers a therapeutic approach for reducing liver-related mortality and morbidity. Hence, the study concludes that ELF can acts as a prognostic tool in determining the outcome of liver diseases in postmenopausal women, however, warrants larger studies.

Source: Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, Burnell M, Harris S, Menon U, Rosenberg WM. The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease. BMC Gastroenterol. 2020 Apr 15;20(1):104.