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10 out of 10 - ten of the greatest health-changing research studies, to have taken place in North Thames over ten years of the CRN

10 out of 10 campaign hepatology

The NIHR Clinical Research Network was formed 10 years ago, in April 2014. To reflect on its mission to support clinical research, we are taking this opportunity to look back on the 10 years of its existence, and revisit some of the incredible research to emerge in the region that has had an impact on treatments and on the health and wellbeing of patients across the UK.

Which aspect of health did this research focus on? 



What was the study investigating?

The development and evaluation of a pathway for the management of patients with non-alcoholic fatty liver disease NAFLD, using a new non-invasive liver fibrosis test. 

The test and pathway aimed to improve earlier detection and better monitoring of cases at the same time as avoiding unnecessary referrals.

Why does it matter?

Chronic liver disease (CLD) has become the third leading cause of death in the UK and is the most common cause of death in people aged 35-49.

Existing tests such as biopsy can be invasive and are not always accurate. Liver diseases often remain undetected until it’s too late to treat them effectively. 


What did the study do?

An earlier series of studies developed and then tested an Enhanced Liver Fibrosis (ELF) test. 

This study then worked with multiple stakeholders including patients, physicians, commissioners and pharmaceutical companies to find the best way to implement and use the test.  

The study looked at over 3,000 patients and followed their progress along different diagnosis pathways, with and without the test. 


What did we learn?

The study showed that the ELF test was more sensitive and more accurate than biopsies and can detect early signs of damage even before symptoms show. 

It demonstrated that these blood tests can be easily used in primary care, leading to a reduction in unnecessary referrals by 80% and greatly improving the detection of cases of advanced fibrosis and cirrhosis.

Results were published in the Journal of Hepatology

ELF was recommended in the NICE Guideline for diagnostic testing for liver disease, is recommended in British Society for Gastroenterology guidelines and gained FDA approval.


How has it benefited patient healthcare and treatments? 

Following its introduction in NHS clinics, ELF has aided a 5-fold improvement in detection of advanced liver disease and an 81% reduction in unnecessary referrals from primary to secondary care with potential cost savings to the NHS exceeding £30 million per year. 


What next?

The ELF test is established in primary and secondary care pathways for asymptomatic non-alcoholic fatty liver disease and alcohol-related liver disease in the NHS, Europe and Australia. It is widely used in the pharmaceutical industry in drug development to monitor the effectiveness of new medicines. The test could be rolled out worldwide and has saved many more lives.