Enhanced Liver Fibrosis (ELF) Score of 11.53: Interpretation and Clinical Significance

An ELF score of 11.53 strongly indicates cirrhosis (F4 stage fibrosis) and requires immediate referral to a hepatologist for specialized care. 1

Understanding ELF Score Ranges and Clinical Implications

ELF scores increase progressively with advancing liver fibrosis stages, with median values of approximately 8.7 for F0, 9.3 for F1, 10.1 for F2, 10.7 for F3, and 12.0 for F4 (cirrhosis) 2
An ELF score of 11.53 falls within the range typically associated with cirrhosis (F4), which is generally considered to be >11.3 1, 3
The sensitivity of ELF score >11.3 for diagnosing cirrhosis is approximately 83% with a specificity of 97% 3
This high score indicates advanced liver damage with extensive fibrosis and architectural distortion of the liver 1, 2

Patients with ELF scores >11.3 have a significantly increased risk of liver-related clinical outcomes, with studies showing a 2.53-fold increased risk of liver-related events for each unit increase in ELF score 4
In a prospective study, 19.2% of patients with ELF scores ≥9.8 experienced liver-related clinical outcomes compared to <1% of patients with scores <9.8 4
An ELF score of 11.53 places the patient beyond the treatment threshold for certain medications like resmetirom, which is not recommended for patients with ELF >11.3 due to likely cirrhosis 1
This score suggests possible portal hypertension, which requires specific management strategies 1

ELF score has demonstrated high diagnostic accuracy for advanced fibrosis with an AUC of 0.90 for diagnosing advanced fibrosis 1
At a cutoff value of 10.5, ELF has a sensitivity of 79% and specificity of 91% for diagnosing advanced fibrosis 1
For cirrhosis diagnosis, ELF shows superior performance compared to FIB-4, with higher diagnostic accuracy particularly in elderly patients 2
ELF is less affected by age than other non-invasive tests like FIB-4, making it particularly valuable in older populations 2

Immediate referral to a hepatologist is essential for comprehensive evaluation and management 1, 5
Additional assessment for complications of cirrhosis should be performed, including:
- Screening for esophageal varices with upper endoscopy 5
- Evaluation for ascites and hepatic encephalopathy 5
- Surveillance for hepatocellular carcinoma with ultrasound ± AFP every 6 months 5
Assessment for portal hypertension is warranted, as an ELF score >10.83 has been associated with clinically significant portal hypertension (sensitivity 88%, specificity 83%) 1
Liver biopsy may be considered to confirm the diagnosis, particularly if there are discordant results between different non-invasive tests 5

ELF score can be influenced by inflammatory processes, not just fibrosis, which may lead to overestimation of fibrosis stage during active inflammation 6
Morning vs. afternoon testing may slightly affect results (afternoon values tend to be slightly higher) 3
Gender differences exist in reference ranges, with men having slightly higher normal values (7.0-9.9) compared to women (6.6-9.3) 3
The score should be interpreted in the context of clinical findings, other non-invasive tests, and the underlying liver disease etiology 1, 5