PLoS neglected tropical diseases · 2026
Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study.
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Thorp Rebecca Dantas, Batista Andrea Dória, Mariz Carolline A, de Araújo Lilian Rose Maia Gomes, Diniz George Tadeu Nunes, Barreto Ana Virgínia Matos Sá, de Morais Clarice Neueschwander Lins, Silva Paula Carolina Valença, Domingues Ana Lúcia Coutinho, Lopes Edmundo Pessoa
Аннотация
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.
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.