Tdl Elf Test

ELF stands for Enhanced Liver Fibrosis. The ELF™ Blood Test is a routine blood test used to assess the severity of liver fibrosis. Liver fibrosis is the scarring process that represents the liver’s response to injury or disease. Chronic liver disease can lead to liver fibrosis, liver cancer and death. Cirrhosis and liver cancer are now among the top ten causes of death worldwide, and in many developed countries, liver disease is now one of the top 5 causes of death in middle age. There are three main causes of fibrosis:

  • Fatty liver disease associated with obesity
  • Viral hepatitis B and C
  • Type 2 Diabetes/Metabolic Syndrome
  • Alcohol Abuse

The ELF Blood Test combines three serum biomarkers, which, when correlated, are able
to identify a quantifiable level of liver fibrosis. The extent of liver damage is determined
by a score based on the measurement of three substances:

  • Hyaluronic acid (HA)
  • Procollagen III amino terminal peptide (PIIINP)
  • Tissue inhibitor of metalloproteinase 1 (TIMP-1)

Elf Test Sample ScaleThe algorithm of these three markers creates an ELF Score. This ELF score has been proven to correlate to the level of fibrosis assessed by liver biopsy. The spectrum of liver disease can range from simple steatosis, to cirrhosis and may be present for many years in the absence of abnormal liver function tests – mild to moderate liver fibrosis can exist without symptoms, which in itself supports its use for early detection and assessment.


Elf ResultsThis test offers the following benefits:

  • Identification of early or significant liver disease.
  • Allows for cost effective screening test and subsequent review/follow-up response to treatment
  • Minimally-invasive routine serum sample vs invasive biopsy
  • Mathematical algorithm to assess extent of liver damage


NICE Guidelines

NICE (July 2016) recommends the use of the ELF test to screen and/or monitor advanced liver fibrosis in people diagnosed with Non Alcoholic Fatty Liver Disease (NAFLD). Risk factors for NAFLD, one of the most common types of liver disease, are high and this group of patients is a primary care challenge. Primary NAFLD is a condition where there is an excess of fat in the liver, not caused by excessive alcohol or secondary causes. NAFLD has become the most chronic liver disease in children and young people in industrialised countries, mainly as a result of obesity. There is no licensed treatment for NAFLD; early diagnosis and management are therefore important at all ages. Link to NICE Guidelines: https://www.nice.org.uk/guidance/ng49/chapter/recommendations.



Liver Fibrosis (Enhanced Liver Fibrosis ELF)


Sample Reqs



B SST/Serum

5-7 days

Special instructions