One-year changes in LSM, but not in ALT and CAP, predict long-term liver outcomes in patients with MASLD.

BACKGROUND: &AIM: The availability of new drugs for the treatment of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) underlines the need of early predictors of response to such therapies. This study evaluated the impact of 1-year changes in liver stiffness measurement by Vibration-Controlled Transient Elastography (LSM by VCTE), controlled attenuation parameters (CAP), and serum alanine aminotransferase (ALT) on liver outcomes in patients with MASLD. METHODS: A large multicenter cohort of MASLD patients with LSM≥8kPa and prospective follow-up was enrolled. Liver-related events (LRE), including hepatocellular carcinoma (HCC) and liver decompensation (LD), were evaluated during follow-up. LSM, CAP, ALT and FIB-4 were assessed at baseline and at 1-year follow-up. Cause-specific Cox regression analyses were performed to correlate 1-year variation in LSM, CAP, ALT and FIB-4 with the risk of developing LRE, LD and HCC, in terms of cause-specific hazard ratios (csHR). RESULTS: We included 1,744 patients with LSM ≥8 kPa (median age 55 years, 52.1% male, 58.3% obese, 55.8% with diabetes) and 989 with LSM ≥10 kPa (median age 56 years, 50.2% male, 54.7% obese, 51% with diabetes), followed for a median of 28.2 and 32 months, respectively. LREs occurred in 39 patients with LSM ≥8 kPa (26 LD, 22 HCC) and in 35 with LSM ≥10 kPa (25 LD, 19 HCC). A 1-year variation in LSM, but not in CAP, ALT, or FIB-4, was independently associated with LRE in MASLD patients with LSM ≥8 kPa (csHR 1.007; 95%CI 1.001-1.014). Likewise, 1-year LSM variation (csHR 1.009; 95%CI 1.000-1.018) independently predicted LD in this population, whereas no 1-year changes in CAP, ALT, or FIB-4 were associated with LD risk. No independent associations were observed between 1-year changes in LSM, CAP, ALT, or FIB-4 and the risk of HCC. All findings were confirmed in patients with LSM ≥10 kPa and in those at high risk of progression with type 2 diabetes. CONCLUSIONS: In MASLD patients with LSM ≥8 or ≥10 kPa, the % LSM reduction at 1 year was independently associated with lower risk of LRE and LD.

Citation

Pennisi G, Infantino G, Di Maria G, Tsochatzis E, Bugianesi E, Yoneda M, Zheng MH, Hagström H, Boursier J, Calleja JL, Boon-Bee Goh G, Chan WK, Gallego-Durán R, Sanyal AJ, de Lédinghen V, Newsome PN, Fan JG, Castéra L, Lai M, Fournier-Poizat C, Lai-Hung Wong G, Armandi A, Nakajima A, Liu WY, Shang Y, de Saint-Loup M, Llop E, Jun Teh KK, Lara-Romero C, Asgharpour A, Mahgoub S, Sau-Wai Chan M, Romero-Gomez M, Lin H, Kim SU, Cheuk-Fung Yip T, Tulone A, Che-To Lai J, Yang B, Lee HW, Desta AA, Ciancimino G, Enea M, Cammà C, Wai-Sun Wong V, Petta S. ONE-YEAR CHANGES IN LSM, BUT NOT IN ALT AND CAP, PREDICT LONG-TERM LIVER OUTCOMES IN PATIENTS WITH MASLD. Clin Gastroenterol Hepatol. 2026 Jan 30:S1542-3565(26)00048-0. doi: 10.1016/j.cgh.2026.01.020. Epub ahead of print.

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Article