Enhanced Liver Fibrosis (ELF) Test

The ELF™ Test

The Enhanced Liver Fibrosis (ELF™) test is a noninvasive blood (serum) lab test, which combines three direct ECM biomarkers: hyaluronic acid (HA), procollagen III aminoterminal peptide (PIIINP), and tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), into a validated composite score. The ELF™ score helps clinicians and researchers assess fibrosis severity and risk in metabolic and chronic liver diseases, including MASLD/NAFLD.

The ELF™ Score

The ELF™ score has been well-validated against biopsy-proven fibrosis across a range of chronic liver diseases (CLD) in both adult and pediatric populations. The three direct markers of the ELF test provide complementary information, and the combined score outperforms both the individual markers and simple scores such as APRI or FIB-4.​

The three analytes of the ELF™ are measured automatically, and the software calculates and reports a unitless numeric score. Increased ELF scores are linked to both biopsy-proven fibrosis and prognosis for clinically significant outcomes (Figure 1).

Interested in ELF™? Contact us!

Why should you measure ELF™ with us?

ELF™ is available on our high-throughput Siemens Atellica IM® platform, which brings automation, consistency, and precision to routine fibrosis assessment. We have been working with specialized lab solutions for more than 15 years, making us experts in this area.

Benefits of measuring with us:

  • Minimal sample volume: We only require 165 µL of serum, reducing patient burden and supporting streamlined sampling in both clinical practice and study settings.
  • Long-term sample stability: Samples are stable for up to 25 months at ≤ –70°C (in-house data) and up to 3 years according to published literature which is ideal for global trials and multi-site studies.
  • Integrated biomarker strategy: complement ELF™ with nordicPRO-C3™, our collagen formation biomarker to get the full picture on active fibrogenesis.

By combining these tools, we offer a more complete fibrosis profile than traditional liver enzymes alone (ASAT, ALAT), which allows for more confident interpretation and decision-making.

Test specifications and laboratory capabilities

Test specifications

  • In-vitro diagnostic multivariate index Assay, FDA granted De Novo Marketing Authorization​
  • Serum-based assay available at Nordic in the high-throughput Attelica IM® System, under a CAP/CLIA-certified Lab and and enrolled in proficiency testing (PT) program ​
  • Volume required: 271 µl Can be run in the same aliquot as PRO-C3, using a combined volume of 362 µl​
  • Sample Stability: stable at ≤ -20°C for up to 12 months. Stable at ≤ -70C for three years, according to literature

Laboratory capabilities​

  • Bi-weekly testing frequency​
  • ​Batch-testing and on-demand testing available​
  • ​Turn-around time up to three working days*
  • Reported as Data transfer, Remote Lab-integration (RLI) or as individual Lab reports*
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    Nordic Bioscience’s assays and services are research use only products and services and do not qualify for medical or diagnostic purposes.

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