Enhanced Liver Fibrosis (ELF) score

• IS NOT A FIRST LINE TEST FOR ABNORMAL LFTs (see DXS SCCCG Primary Care Liver Pathway)
• Ensure Hepatitis B and C, autoimmune screen, immunoglobulins, ferritin – are normal
• The ELF score combines quantitative serum concentration measurements of three fibrosis markers (TIMP-1, PIIINP, and HA) to a single value

NICE suggest that:

• Consider using ELF test in people who have been diagnosed with non-alcoholic fatty liver disease (NAFLD) to test for advanced liver fibrosis
•  Do not use routine liver blood tests to assess for advanced liver fibrosis in people with NAFLD
•  Diagnose people with advanced liver fibrosis if they have:
      An ELF score of 10.5 or above and NAFLD
•  Refer adults and young people diagnosed with advanced liver fibrosis to a relevant specialist in hepatology
• Southampton CCG patients please follow the DXS Primary Care Liver Pathway, the threshold for referral to the community Fibroscan® service is lower
• Explain to people with an ELF score below 10.5 that:
     They are unlikely to have advanced liver fibrosis
      Reassessment for advanced liver fibrosis every 3 years for adults is   
      sufficient for regular monitoring
      No interim tests are needed