For a study, it was determined that in people with liver fibrosis, the noninvasive Enhanced Liver Fibrosis (ELF) score was utilized as a diagnostic tool. The ELF score was made up of three serum markers of extracellular matrix remodeling and fibrogenesis: hyaluronic acid (HA), N-terminal pro-peptide of collagen type III  (PIIINP), and tissue inhibitor of metalloproteinase-1 (TIMP-1). The study assessed the ELF score’s clinical utility in children. About 343 liver-healthy youngsters aged 6 to 17 years were used to establish an ELF score reference interval. In healthy youngsters, the median ELF score of 8.9 was much higher than in healthy adults. ELF scores rose significantly in both female and healthy male controls, peaking around puberty, owing to increasing levels of HA and PIIINP, which were likely explained by increased growth. Only 6.4% of the group of liver-healthy children fell into the normal range when normal adult values were applied. Researchers looked at ELF scores in patients with autosomal recessive polycystic kidney disease (ARPKD) who had probable or definite liver fibrosis. All ELF scores in children with ARPKD fell within the reference intervals derived from a healthy control group.

In youngsters, age and gender-appropriate cut-off values should be used instead of the standard diagnostic cut-off ranges for the ELF score. The clinical use of ELF scores in children is debatable, as children throughout pubertal development had higher ELF scores than individuals with ARPKD and liver fibrosis.