Changes in LSM predict development of liver-related events in NAFLD

Baseline and dynamic changes in liver stiffness measurement (LSM) show an independent and bidirectional association with the risk of developing liver-related events, suggests a study.

In addition, LSM may be used as a noninvasive substitute for clinical outcomes in patients with nonalcoholic fatty liver disease (NAFLD).

This analysis included participants in the NASH Clinical Research Network-led NAFLD Database 2 and 3. The investigators compared the cumulative liver-related events probability by LSM progression and regression status using univariate and multivariable interval-censored Cox regression analyses.

Progression to compensated advanced chronic liver disease (cACLD) was characterized by reaching LSM ≥10 kPa in participants with LSM <10 kPa on initial vibration-controlled transient elastography (VCTE), while regression from cACLD referred to reaching LSM <10 kPa in those with baseline LSM ≥10 kPa.

Liver-related events included liver-related death, liver transplant, hepatocellular carcinoma, MELD >15, development of varices, or hepatic decompensation.

A total of 1,403 participants were analysed. Eighty-nine liver-related events occurred over a mean follow-up of 4.4 years, with an annual incidence rate of 1.5 (95 percent confidence interval [CI], 1.2‒1.8).

Among at-risk participants, 29 percent progressed to LSM ≥10 kPa and 17 percent to ≥15 kPa, while 44 percent and 49 percent regressed to LSM <10 or <15 kPa, respectively.

Individuals who progressed to cACLD had a higher cumulative rate of liver-related events than nonprogressors (16 percent vs 4 percent; adjusted hazard ratio [aHR], 4.0, 95 percent CI, 1.8‒8.9; p<0.01). In contrast, regressors from cACLD had a lower rate of liver-related events than nonregressors (7 percent vs 32 percent; aHR, 0.25, 95 percent CI, 0.10‒0.61; p<0.01).