We’re pleased to share that we have introduced the Enhanced Liver Fibrosis Score (ELFTM) in Ontario as a convenient option for screening for liver fibrosis in Non-alcoholic fatty liver disease (NAFLD) patients. ELF is a panel of three markers for liver extracellular matrix metabolism which reflect the severity of liver fibrosis. The American Association of Clinical Endocrinology recently recommended ELF as a second level test for the screening of liver fibrosis in high-risk patients with intermediate or high FIB-4 index, which LifeLabs also offers. FIB-4 together with ELF can be utilized in a two-step pathway in primary care to assess the risk of severe liver fibrosis and risk stratify patients for triaging for specialist care. The utilization of both tests was shown to significantly reduce the number unnecessary biopsies.
HOW TO ORDER
- Write ‘Enhanced Liver Fibrosis Score (ELFTM) or ‘ELF Score’ in the ‘Other Tests’ section of the standard Ontario MOH requisition
- Your patients can then make an appointment at a LifeLabs Patient Service Centre (PSC) for their blood draw. Patients must present the ELF Score requisition signed by a physician or healthcare provider.
- In general, no patient preparation is required. However, biotin may interfere with testing. Specimens should be collected at least 72 hours after the last biotin supplementation. Fluorescein may also negatively interfere with testing. For patients undergoing fluorescein angiography, specimens should be collected at least 72 hours post-treatment.
- The Enhanced Liver Fibrosis Score (ELFTM) is not insured under OHIP. Cost of test is $275.00.
REFERENCE RANGE AND RESULTS REPORTING
The following interpretive comment will be provided with the ELF Score Report. ELF score ranges and associated risk of disease progression (development of cirrhosis or liver-related events).
- < 9.80 Lower
- or = 9.80 – <11.30 Mid
- > or = 11.30 Higher
Turnaround time of results: 7-8 business days upon receipt at lab.
Patients must present the ELF Score requisition signed by a physician or healthcare provider for their appointment. Clinicians should consider further follow-up with transient elastography or ELF blood test in persons with increased risk of advanced fibrosis and indeterminate or high FIB-4 score. For more information, contact our Ontario Customer Care Centre at: 1-877-849-3637.
Reference: Rinella ME et al. Hepatology. 2023;77:1797–1835. https://doi.org/10.1097/HEP.0000000000000323
Thank you,
Dr. Mohamed Abouelhassan PhD FCACB
Clinical Biochemist, Medical-Scientific Department – Ontario, Laboratory Director Kennedy Laboratory
