Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study
9 affiliations
- 1Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Federal University of Pernambuco [UFPE], Recife, Pernambuco, Brazil.
- 2Department of Internal Medicine, Center of Medical Sciences, Federal University of Pernambuco [UFPE], Recife, Pernambuco, Brazil.
- 3Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil.
- 4Gastroenterology Division, Hospital das Clínicas/EBSERH, Federal University of Pernambuco [UFPE], Recife, Pernambuco, Brazil.
- 5Department of Geoprocessing and Statistics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil.
- 6Maurício de Nassau University Center, Graças Campus, Recife, Pernambuco, Brazil.
- 7Department of Virology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil.
- 8Federal University of Pernambuco [UFPE], Vitória de Santo Antão, Pernambuco, Brazil.
- 9Real Hospital Português [RHP], Recife, Pernambuco, Brazil.
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.
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BibTeX
@article{thorp2026evaluating,
title = {{Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study}},
author = {Rebecca Dantas Thorp and Andrea Dória Batista and Carolline A Mariz and Lilian Rose Maia Gomes de Araújo and George Tadeu Nunes Diniz and Ana Virgínia Matos Sá Barreto and Clarice Neueschwander Lins de Morais and Paula Carolina Valença Silva and Ana Lúcia Coutinho Domingues and Edmundo Pessoa Lopes},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014775},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014775},
note = {CC BY},
}
RIS
TY - JOUR
TI - Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study
AU - Rebecca Dantas Thorp
AU - Andrea Dória Batista
AU - Carolline A Mariz
AU - Lilian Rose Maia Gomes de Araújo
AU - George Tadeu Nunes Diniz
AU - Ana Virgínia Matos Sá Barreto
AU - Clarice Neueschwander Lins de Morais
AU - Paula Carolina Valença Silva
AU - Ana Lúcia Coutinho Domingues
AU - Edmundo Pessoa Lopes
PY - 2026
DA - 2026/10/09
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014775
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014775
AB - 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.
SN - 1935-2735
SN - 1935-2727
ER -