From the Guidelines
FibroTest should be ordered when the FIB-4 score is above 1.3 and TE is not available, while Enhanced Liver Fibrosis test can be used as a secondary risk assessment when elastography is not available.
Key Considerations
- The FIB-4 score is recommended as a first-line assessment for practitioners due to its simplicity and low cost 1.
- When the FIB-4 score is above 1.3, patented serum tests such as FibroTest or Enhanced Liver Fibrosis test can be used to rule-out or rule-in advanced fibrosis 2.
- The Enhanced Liver Fibrosis test is a validated blood-based serum biomarker for detection of advanced hepatic fibrosis and can be used as a secondary risk assessment when elastography is not available 1.
- Vibration controlled transient elastography (VCTE) has a higher sensitivity and specificity for diagnosing cirrhosis compared to FIB-4 and APRI 3.
Test Characteristics
- FIB-4 score: sensitivity 0.74, specificity 0.71 3
- VCTE: sensitivity 0.90, specificity 0.87 3
- Enhanced Liver Fibrosis test: validated for detection of advanced hepatic fibrosis, but specific test characteristics not provided in the evidence 1 ### Clinical Decision Making
- Use FIB-4 score as a first-line assessment for liver fibrosis
- If FIB-4 score is above 1.3, consider using patented serum tests such as FibroTest or Enhanced Liver Fibrosis test to rule-out or rule-in advanced fibrosis
- Consider using VCTE or other imaging-based biomarkers if available and feasible 2, 1, 3
From the Research
Comparison of FibroTest and Enhanced Liver Fibrosis Test
- The Enhanced Liver Fibrosis (ELF) test and FibroTest are two non-invasive tests used to assess liver fibrosis, with comparable diagnostic accuracy 4.
- Both tests have been shown to perform well in identifying patients with advanced fibrosis, with area under the receiver operating characteristic curve (AUROC) values ranging from 0.78 to 0.92 4, 5, 6, 7, 8.
Diagnostic Accuracy
- The ELF test has been shown to have an AUROC of 0.81 for the diagnosis of advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) 5.
- The FibroTest has been shown to have an AUROC of 0.69 for the diagnosis of significant fibrosis and 0.91 for the diagnosis of liver cirrhosis 4.
- A combination of the ELF test and FibroTest may provide higher diagnostic accuracy, with an AUROC of 0.92 for the diagnosis of advanced fibrosis in patients with alcoholic liver disease 8.
Clinical Application
- The ELF test can be used to rule out advanced fibrosis in patients with NAFLD, with a negative predictive value of 95.1% and a sensitivity of 92.5% 5.
- The FibroTest can be used to rule out advanced fibrosis in patients with alcoholic liver disease, with a negative predictive value of 94% and a sensitivity of 90% 8.
- The choice between the ELF test and FibroTest may depend on the specific clinical setting and patient population, with both tests having their own strengths and limitations 4, 5, 6, 7, 8.
Patient Population
- The ELF test has been shown to perform well in patients with NAFLD, with an AUROC of 0.81 for the diagnosis of advanced fibrosis 5.
- The FibroTest has been shown to perform well in patients with alcoholic liver disease, with an AUROC of 0.90 for the diagnosis of advanced fibrosis 8.
- Both tests have been shown to perform well in patients with chronic liver disease, including those with hepatitis C and B virus infection and primary biliary cirrhosis 4.