TIMP1 and fibrosis: The Enhanced Liver Fibrosis (ELF) test, which combines age and circulating extracellular matrix components such as hyaluronic acid (HA), amino-terminal propeptide of type III procollagen (PIIINP), and tissue inhibitor of metalloproteinase-1 (TIMP-1), was successfully used to identify severe fibrosis in NAFLD (sensitivity of 86.7%, specificity of 92.5%, positive predictive value PPV of 72%, and negative predictive value NPV of 97% for a cut-off value ≥ 9.8) [55].