{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:56:07Z","timestamp":1792839367817,"version":"4.5.0"},"reference-count":103,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Patients with liver disease can be stratified for risk of liver\u2010related ill health by degree of hepatic fibrosis. The Enhanced liver fibrosis (ELF) test was developed to quantify hepatic fibrosis non\u2010invasively and is widely used. The objective of this review was to identify and synthesise the evidence on the diagnostic accuracy of the ELF test for staging of hepatic fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Approach &amp; Results<\/jats:title><jats:p>Searches of PubMed and EMBASE were conducted between October 2020 and November 2021 to identify studies reporting the diagnostic accuracy of the ELF test compared to histology in liver disease patients. QUADAS\u20102 was used to assess risk of bias in each study. Meta\u2010analysis using the multiple thresholds model described by Steinhauser S, Schumacher M, R\u00fccker G. Modelling multiple thresholds in meta\u2010analysis of diagnostic test accuracy studies. <jats:italic>BMC Med. Res. Methodol.<\/jats:italic> 2016;<jats:bold>16<\/jats:bold>. 10.1186\/s12874\u2010016\u20100196\u20101 allowed synthesis of 2\u2009\u00d7\u20092 data at different cut\u2010offs. Sixty\u2010three studies were included in this review. These studies included 19,285 patients with or at risk of liver disease from viral hepatitis, Non\u2010Alcoholic Fatty Liver Disease, Alcohol\u2010related Liver Disease and other mixed chronic liver diseases. The prevalence of significant fibrosis, advanced fibrosis and cirrhosis was 47.5%, 39.2% and 4.4%, respectively. Cut\u2010offs with maximal Youden index were generated with AUROC\u00a0=\u00a00.811 (95% CI: 0.736\u20130.870), 0.812 (95% CI: 0.758\u20130.856) and 0.810 (95% CI: 0.694\u20130.888) to detect significant fibrosis, advanced fibrosis or cirrhosis, respectively. Diagnostic accuracy of the ELF test varied between different liver diseases and cut\u2010offs to detect each stage with 95% sensitivity or specificity were also generated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Meta\u2010analysis revealed considerable variability in the ability of ELF to stage fibrosis across disease aetiologies. Research has mostly focused on viral hepatitis and NAFLD. There is currently a lack of data on the value of the ELF test in Alcohol\u2010related liver disease and patients in primary care settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17385","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T06:07:16Z","timestamp":1674022036000},"page":"750-762","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Meta\u2010analysis: Enhanced liver fibrosis test to identify hepatic fibrosis in chronic liver diseases"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5859-2921","authenticated-orcid":false,"given":"Alexander","family":"Hinkson","sequence":"first","affiliation":[{"name":"Leeds Liver Unit St James' University Hospital, Leeds Teaching Hospitals NHS Trust  Leeds UK"},{"name":"Leeds Liver Research Group University of Leeds  Leeds UK"},{"name":"Leeds Institute for Medical Research, University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lally","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Gibson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Jones","sequence":"additional","affiliation":[{"name":"Leeds Liver Unit St James' University Hospital, Leeds Teaching Hospitals NHS Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1288-0749","authenticated-orcid":false,"given":"Ian A.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Leeds Liver Unit St James' University Hospital, Leeds Teaching Hospitals NHS Trust  Leeds UK"},{"name":"Leeds Liver Research Group University of Leeds  Leeds UK"},{"name":"Leeds Institute for Medical Research, University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5350-1018","authenticated-orcid":false,"given":"Bethany","family":"Shinkins","sequence":"additional","affiliation":[{"name":"Test Evaluation Group Leeds Institute for Health Sciences, University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4888-8670","authenticated-orcid":false,"given":"Richard","family":"Parker","sequence":"additional","affiliation":[{"name":"Leeds Liver Unit St James' University Hospital, Leeds Teaching Hospitals NHS Trust  Leeds UK"},{"name":"Leeds Liver Research Group University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60355-4"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.05.011"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28431"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2011.03.020"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21327"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29085"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14362"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-321299"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2008.10.014"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.08.052"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21984"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.09.013"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.009"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24105"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21496"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30383-8"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314924"},{"key":"e_1_2_8_21_1","first-page":"1","article-title":"Non\u2010alcoholic fatty liver disease (NAFLD): summary of NICE guidance","volume":"354","author":"Glen J","year":"2016","journal-title":"BMJ"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.03.033"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30979"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i17.3163"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-019-1039-4"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.036"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30842"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00009"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0111551"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010016\u20100196\u20101"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-10-40"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1997"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.02.021"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.01.005"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1373\/jalm.2018.027359"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15529"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2017(09)01"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.03.016"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.5301\/ijbm.5000292"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0713-1330"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl17092"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640619865133"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000128"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0051906"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29557"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2893.2009.01263.x"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1499-3872(13)60079-X"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12161"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0164883"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.3343\/alm.2018.38.4.348"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12559"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e3182a87e78"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2011-0858"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2016.1233578"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0141649"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04500.x"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14469"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2018.12.005"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0167001"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u2010230X\u201010\u2010103"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2019.06.015"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12760"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-27560-5"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0041964"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/8252980"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2893.2009.01209.x"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.03.016"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1872-034X.2012.01057.x"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-010-0204-1"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13226"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0167776"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-021-01795-5"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1680"},{"key":"e_1_2_8_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2020.106174"},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2020.8798"},{"key":"e_1_2_8_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14491"},{"key":"e_1_2_8_79_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13495"},{"key":"e_1_2_8_80_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa646"},{"key":"e_1_2_8_81_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm7090267"},{"key":"e_1_2_8_82_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30941"},{"key":"e_1_2_8_83_1","doi-asserted-by":"publisher","DOI":"10.1515\/tjb-2017-s108"},{"key":"e_1_2_8_84_1","doi-asserted-by":"publisher","DOI":"10.1002\/nbm.3299"},{"key":"e_1_2_8_85_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0155967"},{"key":"e_1_2_8_86_1","doi-asserted-by":"publisher","DOI":"10.21037\/jlpm.2018.02.06"},{"key":"e_1_2_8_87_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1590-8658(13)60620-9"},{"key":"e_1_2_8_88_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640618792819"},{"key":"e_1_2_8_89_1","doi-asserted-by":"publisher","DOI":"10.2337\/db20-1448-P"},{"key":"e_1_2_8_90_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31579"},{"key":"e_1_2_8_91_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27525"},{"key":"e_1_2_8_92_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000581"},{"key":"e_1_2_8_93_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15482"},{"key":"e_1_2_8_94_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.23923"},{"key":"e_1_2_8_95_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000027403"},{"key":"e_1_2_8_96_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840200104"},{"key":"e_1_2_8_97_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(95)80226-6"},{"key":"e_1_2_8_98_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199512000-00007"},{"key":"e_1_2_8_99_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840010511"},{"key":"e_1_2_8_100_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20701"},{"key":"e_1_2_8_101_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.1977.tb01640.x"},{"key":"e_1_2_8_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.02.034"},{"key":"e_1_2_8_103_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-010-1219-0"},{"key":"e_1_2_8_104_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3139"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17385","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.17385","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17385","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T17:30:06Z","timestamp":1692466206000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.17385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":103,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1111\/apt.17385"],"URL":"https:\/\/doi.org\/10.1111\/apt.17385","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]},"assertion":[{"value":"2022-06-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}