What indicates Elevated Liver Enzymes (ELF)?

From the Guidelines

Elevated Liver Enzymes (ELF) are indicated by ALT > 20 U/L for women and > 30 U/L for men.

Key Indicators of Elevated Liver Enzymes

• ALT levels: Elevated ALT levels are a key indicator of liver damage or disease.
• ELF score: An ELF score of >9.8 is associated with advanced hepatic fibrosis and a higher risk of liver-related complications.
• VCTE values: VCTE values of >9.9 kPa are associated with advanced fibrosis and a higher risk of liver-related complications.

Diagnostic Thresholds

• ALT: > 20 U/L for women and > 30 U/L for men 1
• ELF score: > 9.8 for advanced hepatic fibrosis 1
• VCTE: > 9.9 kPa for advanced fibrosis 1

Clinical Considerations

• Patients with elevated liver enzymes should undergo further evaluation, including screening and/or serologic evaluation for alternate causes of chronic hepatitis 1.
• The ELF score and VCTE values can be used to risk-stratify patients and guide clinical management 1.
• Patients with advanced fibrosis or cirrhosis should be referred to a specialist for further evaluation and management 1.

From the Research

Elevated Liver Enzymes (ELF) Indicators

The following indicators are associated with Elevated Liver Enzymes (ELF):

• Advanced liver fibrosis [(2,3)]
• Liver-related outcomes, such as hospitalization, liver cancer, or liver-related death [(2,4)]
• High body mass index (≥30 kg/m2) 2
• Diabetes 2
• Elevated alanine aminotransferase (>40 U/L) 2
• Non-alcoholic fatty liver disease 3

ELF Test Performance

The ELF test has been shown to:

• Have good discriminative performance in detecting advanced liver fibrosis and predicting liver-related outcomes [(2,3)]
• Be useful in primary, secondary, and tertiary care for the early recognition of liver fibrosis and timely referral to a liver specialist 5
• Have a high diagnostic accuracy (area under the curve (AUC)=0.80,95% CI 0.76 to 0.85) in identification of significant fibrosis on biopsy 4
• Be comparable to liver stiffness measurement (LSM) by FibroScan in diagnosing advanced liver fibrosis 3

ELF Score Interpretation

The ELF score can be interpreted as follows:

• A higher ELF score is associated with a higher risk of liver-related outcomes [(2,4)]
• An ELF score ≥11.3 is associated with a higher 10-year risk of liver outcomes 2
• The predictive ability of the ELF test decreases with time 2
• Age and gender-appropriate cut-off values should be used in children 6