P55 Predicting liver related morbidity and mortality in non-cirrhotic chronic liver disease: early results from the ELUCIDATE trial

<h3>Background</h3> Biomarkers have been validated for the prediction of adverse events in chronic liver disease (CLD) patients with a diagnosis of cirrhosis. We have investigated the performance of biomarkers to predict liver related events (LRE) in a secondary care cohort of patients diagnosed with CLD and thought not to have cirrhosis over 36 months. <h3>Methods</h3> Patients in the prospective ELUCIDATE trial (ELF to Uncover Cirrhosis as an Indication for Diagnosis and Action for Treatable Events) were recruited from 37 centres in the United Kingdom. Eligibility for the study included a registration ELF score of &gt;8.37, age 18–75 and a 6 month history of abnormal LFTs due to any aetiology of CLD. Patients were excluded if they had results compatible with a diagnosis of cirrhosis. Patients were reviewed every 6 months to assess for the development of LRE. The published thresholds for ELF (9.8 and 11.3) and FIB4 (1.3 and 3.25) for advanced fibrosis were validated at their ability predict all LRE and LRE related to portal hypertension (PHTN-LRE). <h3>Results</h3> 873 patients were randomised (male 56%, mean age 53, range 22–74). Primary diagnosis at randomisation was viral hepatitis(40%), MASLD(27%), alcohol(8%) and ‘unknown/other’(26%). A BMI&gt;30 was recorded for 63% of the ‘unknown/other’ group. LRE occurred in 28 patients including 5 liver related deaths with 11 HCC and 17 PHTN-LRE. All 873 patients had an ELF test at baseline of which 819 had available blood tests to allow FIB4, APRI and AST:ALT ratio to be calculated; 24 of the 819 patients had an LRE. The AUC for ELF (n=873) at predicting LRE was 0.85 and PHTN-LRE was 0.91. Comparative AUC (n=819) for predicting LRE were 0.84(ELF), 0.79(FIB4), 0.74 APRI), 0.67(AST:ALT ratio) and for PHTN-LRE were 0.90(ELF), 0.85(FIB4), 0.81(APRI), 0.75(AST:ALT ratio). Importantly, all 3 patients with ELF &lt;9.8 and LRE (2 HCC) were diagnosed with viral hepatitis. <h3>Conclusion</h3> In this cohort of patients both ELF and FIB4 performed well at predicting LRE during a follow up of up to 36 months. Most patients in this cohort had either a low or indeterminate FIB4 score (91%) with &gt;50% of all LRE developing in patients with these scores. Regardless, ELF at the 9.8 threshold identified 79% of patients with either a low or indeterminate FIB4 score who would develop LRE, rising to 100% in patients without viral hepatitis. In keeping with recent studies, an ELF score &gt;13.0 is associated with a high risk of developing LRE.