[20] The enhanced liver fibrosis test (ELF test), which consists of a panel of direct biomarkers that includes hyaluronic acid (HA), procollagen III N-terminal propeptide (PIIINP) and tissue inhibitor of metalloproteinase 1 (TIMP-1), can detect liver cirrhosis adequately in most cases at a cut-off value >9.3, and the ELF test has a sensitivity of 93% and a specificity of 86%. This evidence concerns the gene TIMP1 and cirrhosis of liver.