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Test Code ELF Enhanced Liver Fibrosis (ELF) Score

Important Note

Order LABRFELF in Epic

Specimen and Container/Tube

Red Top (serum) 

Collection Instructions

  1. Draw blood in plain Red top tube
  2. Centrifuge between 1000 - 2000 x g for 10 minutes within two hours after collection
  3. Aliqout 1.0 mL of serum in plastic vial with screw cap

Dietary supplements containing biotin may interfere in assays and may skew analyte results to be either falsely high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at least 8 hours following the last biotin supplementation. For patients on mega-doses of biotin supplements, draw samples at least 72 hours following the last biotin supplementation.

Samples with fluorescein may cause falsely depressed results. Evidence suggests that patients undergoing retinal fluorescein angiography can retain amounts of fluorescein in the body for up to 72 hours post-treatment.

Specimen Handling and Transport Instructions

Transport Temperature

Refrigerated

Rejection Criteria

Gross hemolysis

Reference Values

Reference Range(s)

<9.80

ELF score ranges and associated risk of disease progression (development of cirrhosis or liver-related events):

<9.80 Lower
≥9.80 - <11.30 Mid
≥11.30 Higher

Clinical Indications

Enhanced Liver Fibrosis (ELF) Score - The Enhanced Liver Fibrosis (ELF) score predicts progression to cirrhosis and liver-related events in patients with advanced fibrosis due to NASH.

The ELF score is not for use in the diagnosis of NASH, the staging of fibrosis, the serial monitoring of disease progression, or the monitoring of effects of therapeutic products.

The ELF score is derived from an algorithm that combines measurements of PIIINP, TIMP-1, and HA. PIIINP is a marker of early fibrogenesis and inflammation, TIMP-1 is the circulating inhibitor of MMP enzymes that can enhance fibrogenesis, and HA is a glycosaminoglycan that is produced by hepatic stellate cells. Together, these assays measure qualitative and quantitative changes in the extracellular matrix (ECM). The ECM refers to a set of macromolecules that comprise the extracellular scaffolding of the liver. Some ECM markers reflect fibrogenesis and others reflect fibrosis regression, allowing for a dynamic evaluation of ECM activity.

LOINC Codes

88055-9

Methodology

Chemiluminescent Immunoassay

Synonyms/Keyword Search

hyaluronic, P3NP, procollagen, metalloproteinase, hepatic, PIIINP, propeptide, NASH, NAFLD, Nonalcoholic, Fatty, Steatosis, Hepatitis, Steatohepatitis, TIMP

CPT Code(s)

81517

Turnaround Time

Set up: Tues, Thurs, Sat; Report available: 3-5 days

Specimen Stability

  • Room temperature: 48 hours
  • Refrigerated: 7 days
  • Frozen: 30 days

Volume

Specimen Volume:  1 mL serum

Minimum Volume: 0.5 mL

Performing Laboratory

Quest Diagnostics Nichols Institute-San Juan Capistrano, CA
33608 Ortega Highway
San Juan Capistrano, CA 92675-2042