Uncovering unsuspected advanced liver fibrosis in patients referred to alcohol nurse specialists using the ELF test

Freya Rhodes, Sara Cococcia, Jasmina Panovska-Griffiths, Sudeep Tanwar, Rachel H. Westbrook, Alison Rodger, William M. Rosenberg

Research output: Contribution to journalArticlepeer-review


Background and aims: Alcohol use disorders (AUD) cause 7.2% of UK hospital admissions/year. Most are not managed by hepatologists and liver disease may be missed. We used the Enhanced Liver Fibrosis (ELF) test to investigate prevalence and associations of occult advanced liver fibrosis in AUD patients not known to have liver fibrosis. Methods: Liver fibrosis was assessed using ELF in prospective patients referred to the Royal Free Hospital Alcohol Specialist Nurse (November 2018–December 2019). Known cases of liver disease were excluded. Patient demographics, blood tests, imaging data and alcohol histories recorded. Advanced fibrosis was categorised as ELF ≥ 10.5. Results: The study included 99 patients (69% male, mean age 53.1 ± 14.4) with median alcohol intake 140 units/week (IQR 80.9–280), and a mean duration of harmful drinking of 15 years (IQR 10–27.5). The commonest reason for admission was symptomatic alcohol withdrawal (36%). The median ELF score was 9.62, range 6.87–13.78. An ELF score ≥ 10.5 was recorded in 28/99 (29%) patients, of whom 28.6% had normal liver tests. Within previous 5-years, 76% had attended A&E without assessment of liver disease. The ELF score was not associated with recent alcohol intake (p = 0.081), or inflammation (p = 0.574). Conclusion: Over a quarter of patients with AUD had previously undetected advanced liver fibrosis assessed by ELF testing. ELF was not associated with liver inflammation or recent alcohol intake. The majority had recent missed opportunities for investigating liver disease. We recommend clinicians use non-invasive tests to assess liver fibrosis in patients admitted to hospital with AUD.

Original languageEnglish
Article number143
JournalBMC Gastroenterology
Issue number1
Publication statusPublished - Dec 2021
Externally publishedYes


  • Alcohol use disorder
  • Alcoholic
  • Enhanced liver fibrosis test
  • Liver cirrhosis
  • Liver diseases
  • Non-invasive test

ASJC Scopus subject areas

  • Gastroenterology


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