Using the enhanced liver fibrosis test to identify disease in at-risk populations

Steatotic liver disease is common and has increased prevalence among those with type II diabetes mellitus or hazardous alcohol use. Identifying individuals with advanced liver disease early through screening may afford timely opportunities to reduce disease progression. This study assesses the application of non-invasive tests in at-risk populations to identify clinically important disease.

The enhanced liver fibrosis (ELF) test and liver stiffness measurement (LSM) were used as non-invasive means to assess risk of fibrosis in two at-risk populations in Leeds, UK. Patients in a community diabetes clinic and patients with hazardous alcohol use attending alcohol treatment services between March 2019 and March 2020 were offered ELF testing alongside routine review. Those with ELF ≥9.5 were offered LSM.

In total, 972 patients were assessed, of whom 325 underwent both ELF and LSM. Patients referred from the diabetes clinic were typically older and had higher body mass index values, while alanine aminotransferase and serum bilirubin values were higher in those referred from alcohol services. Forty-five per cent of patients referred from the diabetes service had an ELF score below 9.5, and only 7.9% undergoing LSM had readings ≥15 kPa. Seventy-two per cent of patients referred from the alcohol service had ELF scores below 9.5, with 31% subsequently having LSM values ≥15 kPa.

Steatotic liver disease is relatively common in those with risk factors and particularly those drinking excess alcohol. Strategies for identifying at-risk individuals may help to increase early diagnosis, though care must be taken when selecting appropriate tests.