{ "abstract": "Background: Measuring the periportal fibrosis pattern (PPF) in schistosomiasis mansoni (SM) is essential for diagnosing portal hypertension. The Enhanced Liver Fibrosis (ELF) test can be used to quantify liver fibrosis, however, few studies have been done in SM. This study evaluated serum ELF value according to the PPF pattern established by the Niamey ultrasound classification (US) and history of upper gastrointestinal bleeding (UGIB) in patients with SM. Methodology: A cross-sectional, bidirectional analytical study was carried out with patients from an endemic area and from a reference outpatient clinic for SM. A structured questionnaire was applied to collect sociodemographic and clinical data, and blood samples were collected for ELF determination. US was performed by the same examiner. Principal Findings: Among the 196 patients evaluated (58% women; mean age of 45.04 years ± 15.30 years) 18 (%) presented with Niamey US pattern A + B; 64 (%) pattern C; 56 (%) pattern D; 49 (%) pattern E and 9 (%) pattern F. The median ELF values were higher the greater the PPF intensity: 8.36 in A + B; 8.40 in C; 8.64 in D; 8.99 in E and 9.75 in F Niamey pattern (p = 0.0021). There was no difference in the mean ELF serum value between patients with and without history of UGIB. The ELF was able to differentiate patients without PPF, with mild, moderate and advanced PPF: A + B vs C vs D vs E + F (p = 0.0024), as well as patients with advanced PPF from those without fibrosis or with moderate fibrosis: A + B vs E + F (p = 0.0464) and C + D vs E + F (P = 0.0007). Conclusion/ /Significance: The ELF test demonstrated potential as a tool for assessing PPF in SM patients, as it could differentiate those with minimal fibrosis from those with moderate or advanced fibrosis. Author summary: Schistosomiasis is considered one of the main causes of fibrogenic liver disease and affects more than 250 million people worldwide. The diagnosis of the presence and severity of periportal fibrosis (PPF) is essential for preventing its complications, especially in patients with more advanced patterns of PPF, who may present portal hypertension and are subject to upper gastrointestinal bleeding. The liver fibrosis evaluation is through direct or indirect markers, used alone or together, known as indices. The Enhanced Liver Fibrosis (ELF) test is an index that combines three markers: hyaluronic acid, tissue inhibitory factor of metalloproteinases-1 (TIMP-1) and amino-terminal propeptide of type III procollagen (PIIINP). This index has demonstrated prognostic value in the early stages of chronic hepatitis B and C or autoimmune hepatitis and can predict clinical outcomes. In this study, the ELF was able to separate patients without PPF or with doubtful PPF from the other patterns, as well as separating those with advanced or very advanced PPF from the others with less PPF. This capacity becomes fundamental in primary healthcare units, as the doctor has the right tools to triage the most serious cases. The results were promising as the ELF numerical value increased in line with the progression of PPF patterns.", "abstract_shown": true, "affiliations": [ "Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Federal University of Pernambuco [UFPE], Recife, Pernambuco, Brazil.", "Department of Internal Medicine, Center of Medical Sciences, Federal University of Pernambuco [UFPE], Recife, Pernambuco, Brazil.", "Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil.", "Gastroenterology Division, Hospital das Clínicas/EBSERH, Federal University of Pernambuco [UFPE], Recife, Pernambuco, Brazil.", "Department of Geoprocessing and Statistics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil.", "Maurício de Nassau University Center, Graças Campus, Recife, Pernambuco, Brazil.", "Department of Virology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil.", "Federal University of Pernambuco [UFPE], Vitória de Santo Antão, Pernambuco, Brazil.", "Real Hospital Português [RHP], Recife, Pernambuco, Brazil." ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Rebecca Dantas Thorp", "orcid": "0000-0001-9628-3233" }, { "affs": [ 1 ], "name": "Andrea Dória Batista" }, { "affs": [ 2 ], "name": "Carolline A Mariz", "orcid": "0000-0002-7651-9429" }, { "affs": [ 3 ], "name": "Lilian Rose Maia Gomes de Araújo" }, { "affs": [ 4 ], "name": "George Tadeu Nunes Diniz" }, { "affs": [ 5 ], "name": "Ana Virgínia Matos Sá Barreto" }, { "affs": [ 6 ], "name": "Clarice Neueschwander Lins de Morais" }, { "affs": [ 7 ], "name": "Paula Carolina Valença Silva" }, { "affs": [ 0, 1 ], "name": "Ana Lúcia Coutinho Domingues" }, { "affs": [ 0, 1, 3, 8 ], "name": "Edmundo Pessoa Lopes" } ], "bibtex": "https://research.draconitic.com/paper/5dkxy9ym1qk7q.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014775", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014775", "id": "5dkxy9ym1qk7q", "issns": [ "1935-2735", "1935-2727" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014775", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2405|Parasites and Host Interactions" ], [ "plos", "/Biology and life sciences/Developmental biology/Fibrosis" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Hemorrhage" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Ultrasound imaging" ], [ "plos", "/Medicine and health sciences/Gastroenterology and hepatology/Liver diseases" ], [ "plos", "/Medicine and health sciences/Gastroenterology and hepatology/Liver diseases/Alcoholic liver disease" ], [ "plos", "/Medicine and health sciences/Gastroenterology and hepatology/Liver diseases/Liver fibrosis" ], [ "plos", "/Medicine and health sciences/Gastroenterology and hepatology/Liver diseases/Portal hypertension" ], [ "plos", "/Medicine and health sciences/Medical conditions/Parasitic diseases/Helminth infections/Schistosomiasis" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Neglected tropical diseases/Schistosomiasis" ], [ "plos", "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Ultrasound imaging" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Hemorrhage" ], [ "plos", "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Ultrasound imaging" ] ], "openalex": "W7221130565", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014775&type=printable", "pmcid": "PMC13671643", "pmid": "42853889", "published": "2026-10-09", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/5dkxy9ym1qk7q.ris", "sources": [ { "first_seen": "2026-10-30T12:17:30Z", "native_id": "10.1371/journal.pntd.0014775", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014775" }, { "first_seen": "2026-10-30T12:18:12Z", "native_id": "MED:42853889", "source": "europepmc", "url": "https://europepmc.org/article/MED/42853889" } ], "subjects": [ { "field": "medicine", "origin": "plos:diagnostic radiology", "subfield": "imaging" } ], "title": "Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study", "title_text": "Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:12Z", "url": "https://research.draconitic.com/paper/5dkxy9ym1qk7q", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }