Unreliable ELF Score and contradictory test results?

[Jimguru]

My ELF score has increased over 3 months from 9.91 to 10.36, but repeated Fibroscans show reassuring results of 4.2kPA, 3.8kPA and 3.6kPA. I have lost over 20kg in weight and cut back alcohol by 90%. AST and ALT levels have reduced substantially and are back in normal ranges. My CAP score is 290. My consultant says I have fatty liver and need to continue to diet and cut back alcohol, but I should not be too worried by ELF score on its own as it is not consistent with other improving test results. Has anyone else had such a high degree of variation in test results or know of any non-liver reasons for a high ELF score? should I seek a second opinion or just be grateful for good results from Fibroscans

[Hidden]

Hello Jimguro, I used to believe that the ELF test with marks was a fairly reliable test.

However, I have since been reliably informed by a very respected hepatologist in London, that this might not be the case. He argues that a person can have Fibrosis elsewhere in the body and not just the liver. This could then lead to a possible false reading.

I just thought I'd mention it. Good Luck

[Jimguru in reply to Hidden]

Thanks Richard64. I think your reply generally reassuring, although also a little bit concerned where else I might have fibrosis? Regards!

[Laura009 in reply to Jimguru]

You can get fibrosis of the lungs ... pulmonary fibrosis

Laura

[Jimguru in reply to Laura009]

Yes ...thanks for reply........I have googled that you can also get fibrosis in lungs and heart, but having lost some weight my blood pressure and breathing is normal and I am generally very active, so I would have thought I would know about fibrosis elsewhere......My consultant has recommended repeating all liver tests in 3 months and continuing to avoid alcohol, so I shall do as told, but perhaps also arrange a full health check.....

[Laura009 in reply to Jimguru]

Sounds like a very good idea. It's good news that you don't have breathing difficulties. Hope you get some reassuring results.

All the best

Laura

[Haddley in reply to Hidden]

Hello Hidden, hope you are well. Your post seems to be the only post that is calming me down a bit, but I'm still quite worried as my elf was 8.3 5 weeks ago but now is 9.6. after 8.3 score, GP said no need for scan, now after 9.6 he has referred me for a scan. I got ill in July 2020. Body was fighting something as neutrophils dropped to 1.3 and white cells raised. ALT has been raised to 58 since July. GP did full liver screen ruling out all causes of liver damage. I don't drink. So he said it's fatty liver non-alcoholic. I don't have terrible diet, but have lost 10kg since problems started and cut all bad food. I feel the bout of illness caused damage to my liver but I'm not ruling fatty liver out. You seem to know a specialist who advised not to worry too much about elf but many say it's very accurate? What are your thoughts? I am waiting for my fibroscan. I had negative covid19 test in summer, but perhaps covid19 affected my liver. Very disheartening elf to go from 8.3 to 9.6 in 5 weeks

[AyrshireK in reply to Haddley]

Unfortunately you are unlikely to get a reply from the poster, when someone is marked 'Hidden' it means they have closed their account.

Hopefully your scan will reveal more and give you some better answers. From looking up the ELF test score chart anything between 7.7 and 9.8 'might' indicated moderate fibrosis so it would be wise for this to be followed up to ascertain if this is in fact correct (your scores of 8.3 & 9.6 are both within this bracket so actually no 'significant' change). There are other causes of liver disease than NAFLD and alcohol so as a none drinker they need to discover what is going on. With an ALT of 58 there is some mild inflammation but nothing scary of the scale (i've seen Auto Immune Hepatitis patients with results into the 1000's).

Get your next tests and take if from there, if you don't feel you are getting sufficient answers from your GP ask for referral to a liver specialist or at least a gastroenterologist.

All the best, Katie

[Haddley in reply to AyrshireK]

Hi Katie, thank you very much for taking the time to reply - that is extremely nice of you. Thank you for your thoughts and advice. Yes I feel my GP has rushed too quickly to a fatty liver diagnosis as NICE guidance does say this can only be confirmed by ultrasound. The GP did a full liver screen for hep A, B and C and autoimmune hep and loads of other stuff. All this was ruled out about 5 to 6 weeks ago when ELF was 8.3. I would accept the fatty liver diagnosis if it were not for getting very unwell when all this started in summer - I'm still neutropenic and although white cells have normalised now, back when I felt dreadful my lymphocytes were raised so I was clearly fighting some kind of infection. I had a negative covid19 test but was tested late into my illness which dragged on for two months, headaches, dizzy, aches n pains, no temperature or fever. All very strange. Indeed, I will await my fibroscan and hopefully it comes back between 2 and 7kpa which I believe shows a good/normal elasticity for liver. And I will ask for US to confirm fatty liver or not. I'm 33 and never had any health issues, quite fit and BMI 26. Have always eaten good food and overindulged in crisps and perhaps over ate too often. Regardless of liver, I've turned diet and lifestyle around, lost 10kg and eating extra healthy. The ELF score at 8.3 I took on the chin, but 9.6 scared me. Sorry to babble on, thanks again for your reply.

[Jimguru in reply to Haddley]

I have had 3 ELF tests in past 18 months with scores of 9.9, 10.4, 10.2.....but fibroscans of my liver have only shown mild fatty liver. I have lost weight, cut back on booze and increased exercise and my consultant has told me to get on with life and not worry too much. A high ELF score is clearly a warning sign, but can not be used on its own......All the best.......

[Poe2012 in reply to Jimguru]

Hi, posted today about my elf score dr said its normal but give no score, then I found out its 10.1 but again said that normal and he won't refer me for a scan, he is only doing another elf test in 3 years, worried my score so high and no further action is getting taken, especially when above 9.8 is supposed to be a sign of severe fibrosis, worried alot.

Paul

[AyrshireK in reply to Poe2012]

This is an excerpt from the NHS 'University of the North Midlands' guidance on ELF results. uhnmpathology.com/test/enha...

Background:

In conjunction with other laboratory findings and clinical assessments, an ELF Score can aid the diagnosis and assessment of the severity of liver fibrosis in patients with chronic liver disease. It has recently been recommended by NICE in the assessment and monitoring of fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) (see NICE NG49: nice.org.uk/guidance/ng49).

As per the locally agreed primary care pathway, the ELF test should be considered for the assessment of liver fibrosis in adult patients with NAFLD.

An ELF Score ≥10.51 suggests advanced liver fibrosis and is an indication for referral to a specialist in hepatology. If the ELF Score is <10.51, then advanced liver fibrosis is unlikely.

Assuming no other indications for referral, patients should be managed in primary care, offered lifestyle advice and retested using ELF in 3 years (please note: repeat requests made within this time frame will be rejected by the laboratory).

So according to that your doctor is correct in saying your score isn't indicatory of advanced liver fibrosis and is following the appropriate monitoring regime in saying re-test in 3 years. You should now really seriously look at making the appropriate lifestyle - dietary and exercise - to reduce your score and improve your liver health.

Katie

[Poe2012 in reply to AyrshireK]

Thankyou for reply, I did drink alot then went 7yrs no drink, when lockdown started I drank for 3 days solid ended up alcohol hepatitis and lft raised they returned to normal after 7 week, I then have not drank again for 15 months, so 3 day drink in 8 yrs and score is 10.1, when I had the alcohol hepatitis last yr I changed diet and now exercise and as I say no drink for 15 month again after a 7 Yr rest before also, so I was worried with that score.

Paul

[T1ap]

hi. I also had a very high ELF score. 12.8. But then discovered that it is not organ specific, and my bloods had been taken just after hip surgery, when all kinds of inflammation is rife.