Liver Fibrosis Testing

The Fibrosis-4 (FIB-4) Index and the Enhanced Liver Fibrosis (ELF^TM) score are two available non-invasive options for liver fibrosis screening that are particularly useful for patients who have NAFLD/NASH. Both tests are simple, accurate methods that use blood samples to assess the risk of developing advanced liver fibrosis.

Fibrosis-4 (FIB-4) Index*

The FIB-4 index is a simple, accurate, non-invasive, liver fibrosis test index that is calculated from other test results and age. The calculated score can act as a ‘red flag’ for early identification of NAFLD patients at high risk of developing advanced liver fibrosis. It is also a potential alternative to liver biopsy for the screening and managing of patients with liver disease. The American Association of Clinical Endocrinology (AACE) guidelines recommends ordering the FIB-4 index as the preferred test for the screening for clinically significant fibrosis in NAFLD patients.

*Please note that currently, the FIB-4 Index is only available in Ontario

Enhanced Liver Fibrosis (ELF) Score*

The Enhanced Liver Fibrosis (ELF™) Score is also a simple, accurate, non-invasive blood test that calculates a score to measure advanced liver fibrosis. It is used with other laboratory findings and clinical tests in patients with advanced fibrosis due to NASH to assess the likelihood of their disease progressing to cirrhosis. According to the AACE guidelines, ELF™ is recommended as a follow up test in high-risk patients with intermediate or elevated FIB-4 results.

ELF™ is a straightforward blood test that reduces the need for complex or uncomfortable procedures and provides valuable information that helps patients make proactive choices about their health and treatment. Supported by clinical guidelines, ELF™ is a reliable non-invasive tool that can be used by general practitioners for early detection, helping to reduce long wait times for a specialist appointment and liver scans, particularly in geographical areas with limited access.

*Please note that the ELF™ Score is now available in both Ontario and British Columbia

If you have the risk factors for development of NAFLD, like Type 2 diabetes, obesity, metabolic syndrome, elevated liver enzymes, hypertension, and high cholesterol, you should speak to your health care provider about liver fibrosis testing with a simple blood test like the FIB-4 Index or ELF™ before being referred to a liver specialist.

Your health care provider may order the FIB-4 and/or ELF™ if tests done for other reasons point to a liver problem or if you have an abnormal liver enzyme test. Because liver fibrosis in the early stages typically causes no symptoms, early screening of patients in high-risk groups is recommended.

Testing is completed by LifeLabs at a Patient Service Centre or via our mobile lab service (available in select cities) through a simple blood sample. You will require a completed and signed test requisition from your health care provider.

You can order ELF™ score in Ontario here.

You can order ELF™  score in British Columbia by visiting the closest LifeLabs’ Patient Service Centre.
Please note:

The FIB-4 index is currently available at LifeLabs locations in Ontario only

The ELF™ Score is now available at LifeLabs locations in both Ontario and British Columbia

Test results for both FIB-4 and ELF™ will be provided directly to your health care provider for discussion with you. The FIB-4 report will indicate your risk of developing advanced liver fibrosis. The ELF score will indicate your risk of disease progression to fibrosis and cirrhosis. Your health care provider will interpret the results of one or both tests along with your medical history, clinical presentation, and other findings, and may recommend further testing and follow up with a liver specialist.