Among the blood tests for non-invasive assessment of liver fibrosis, the Enhanced Liver Fibrosis (ELF) test is considered to be a “direct” marker of liver fibrosis since it combines the evaluation of three different products involved in extracellular matrix breakdown, namely hyaluronic acid, N-terminal pro-peptide of collagen III, and tissue inhibitor of metalloproteinase-1. This evidence concerns the gene TIMP1 and Hepatic fibrosis.