Elf score what is

Tien, P. Dig Dis Sci 65, — Download citation. Published : 11 December Issue Date : April Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search SpringerLink Search. Download PDF. References 1. Article Google Scholar 2. Article Google Scholar 4. Article Google Scholar 6. Article Google Scholar 7.

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Cite this article Tien, P. Copy to clipboard. One patient was excluded from the analysis as they were found to have an ALT of 1, following a pregabalin overdose, reducing the sample size from to Data were anonymised and entered into a password protected spreadsheet held on a secure NHS computer. AUDIT scores were not available. It was noted if the patient had been actively drinking up to the point of presentation to hospital.

An ELF threshold of Secondary outcomes investigated potential risk factors for advanced fibrosis including alcohol consumption, BMI, age, sex, deprivation score and smoking status.

In addition, missed opportunities for diagnosis of liver disease were assessed by counting the number of attendances to hospital within the previous five years without assessment for liver fibrosis. Blood samples were also taken to screen for viral, immunological and metabolic causes of liver disease in accordance with current protocols if these tests had been omitted during their hospital admission.

As this is an exploratory investigation, following statistical advice we accepted a precision of estimate at 0. A post-hoc sample size calculation for 0. Demographic information was described using frequencies and percentages for categorical variables. Continuous data were described using means and SD or medians and IQR, depending on the normality of the data. After univariate analyses, to determine the variables associated with the presence of advanced fibrosis with the most significance, a multiple binary logistic regression analysis model was used, using the literature-based ELF threshold of Variables were selected if they were established in the literature as risk factors for liver fibrosis, and if they had p values less than 0.

Average BMI was The two patients seen in the ASN outpatient clinic had not been drinking alcohol within the past 3 months, and one inpatient had stopped drinking three weeks prior to hospital admission.

The median duration of alcohol consumption was 15 years IQR 10— The most common reason for presentation to hospital was symptomatic alcohol-withdrawal The vast majority The median ELF score in the whole cohort was 9. Twenty-eight participants In addition, correlations were investigated between these same characteristics and ELF as a continuous variable.

However, there was no correlation observed between alcohol consumption and ELF score viewed as a continuous variable Fig. Furthermore, multivariable regression analysis revealed no association between alcohol consumption and ELF score Table 2. Influence of alcohol and age on binary and continuous ELF scores.

Statistical test: Mann Whitney U, p value significance set at 0. There was no significant difference in ELF score between the quartiles either when ELF was analysed as a continuous score or using the See Additional file 1 : Tables S1 and S2. For every years increase in age, the ELF score increased by 0. S1a, b. The mean FibroScan value was Using a literature-derived threshold of 9.

Over a quarter None of these patients had been assessed previously for liver fibrosis or referred to a liver specialist. Missed opportunities for recognising and assessing liver damage in primary care were not investigated in this study, but none of the patients in this study had been referred to hepatology services for assessment of liver disease prior to diagnosis in this study.

ELF score has been found to correlate with age in some [ 16 , 17 ], but not all studies [ 18 ] and it is unclear how much of the reported correlation is due to the increased likelihood of advanced fibrosis being present in older patients [ 19 ].

McPherson et al. They suggested the use of adjusted thresholds for diagnosing advanced fibrosis in this age range. Fagan et al. Thiele et al. In contrast Parkes et al.

Whilst it has previously been reported that ELF scores may be influenced by inflammation [ 17 , 22 ], we did not find any correlation between ELF score and ALT or AST, as markers of hepatic inflammation in this study, suggesting ELF was not influenced by inflammation in our cohort in keeping with findings of Thiele et al. It must be noted, however, that patients with acute alcoholic hepatitis or acute liver injury from non-alcohol-related causes were excluded as ELF is not validated in these settings.

Limitations of this study include the lack of paired biopsies that would have provided a more robust reference standard assessment of liver fibrosis. However the use of non-invasive tests to assess liver fibrosis in in this study is representative of current clinical practice within the NHS and in many other countries, where patients presenting to hospital with AUD are not routinely biopsied, partly due to increasing recognition of the imperfections of biopsy as a test for liver fibrosis due to sampling error, inter and intra observer variability and the costs and hazards associated with biopsy [ 23 , 24 ].

The small number of patients attending for FibroScan means that it is not possible to draw robust conclusions about the performance of FibroScan in this cohort. Furthermore, the poor attendance rate illustrates both the need to assess patients while they are inpatients, and the greater reliability of using a blood test to assess fibrosis that can be incorporated in routine investigations.

Unfortunately, it is not local routine practice to obtain AUDIT scores but these would provide additional valuable information about drinking behaviour. Although liver stiffness as measured by FibroScan reduces significantly on withdrawal of alcohol [ 25 , 26 , 27 ], a study of ten patients found that there was no significant difference in the ELF scores recorded from intoxicated patients when re-tested two weeks after alcohol withdrawal [ 28 ] but the impact of drinking on ELF score needs further investigation.

Overall, this study has highlighted the missed opportunities for detecting liver fibrosis in at-risk patients in a hospital setting. Alcohol use disorder must be viewed as a multimorbid condition with psycho-social morbidity and the potential to damage every organ in the body. However, alcohol related liver disease accounts for much of the mortality and costs of drinking and accurate and relatively inexpensive blood tests are now available that permit detection of liver damage in all those at risk.

It could be argued that there is no longer any excuse to miss the diagnosis of liver fibrosis in patients presenting to hospital with AUD. Whilst people with AUD encompass some of the more socially disadvantaged members of society that may find engaging with routine health services difficult, it is imperative that all opportunities to detect liver fibrosis should be taken especially on those occasions when they present to hospital with complications of AUD or other conditions.

This study emphasises the importance of implementing this guidance and incorporating it into hospital guidelines in emergency departments and in alcohol care teams [ 29 ] to improve the detection of advanced fibrosis in people with AUD. On publication of this article, the dataset will be made available from the corresponding author on reasonable request.

Accessed 20th Nov Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Article Google Scholar. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

See also NICE's cirrhosis guideline. This is referred to as bridging fibrosis the presence of fibrosis linking hepatic veins to portal tracts. A group of chronic conditions that indicates increased cardiovascular risk.

It includes central obesity excessive abdominal fat , insulin resistance or type 2 diabetes, hypertension and dyslipidaemia. Pioglitazone is contraindicated in people with a history of heart failure, previous or active bladder cancer and uninvestigated macroscopic haematuria visible red blood cells in the urine.

Known risk factors for these conditions, including increased age, should be carefully evaluated before treatment: see the manufacturers' summaries of product characteristics for details.