Originally published by our sister publication Gastroenterology & Endoscopy News
WASHINGTON—Long-term liver screening is feasible, according to new research presented at The Liver Meeting 2025 that identified patients who should be prioritized for screening to prevent progression to cirrhosis or hepatocellular carcinoma.
Vibration-controlled transient elastography (VCTE) is a noninvasive screening method that can reliably exclude liver fibrosis. However, most of the available data have been collected in highly selected populations, said Jesse Pustjens, a PhD candidate at Erasmus University Rotterdam, in the Netherlands (abstract 0176).
“We know that the prevalence of elevated liver stiffness in the general population is about 5.5%, but the dynamics of liver stiffness within the general population remain unknown. This information is essential for developing safe and feasible screening algorithms in the general population,” he said.
To this end, the LiverScreen Study, with cohorts in Spain, the Netherlands, and Denmark, sought to determine the proportion of clinically significant changes in liver stiffness over time in the general population, as well as risk factors for those changes.
“A clinically significant increase was defined as a negative baseline screening, below 8 kPa, to an increase above 8 kPa at follow-up, with at least a 30% change. Conversely, a clinically significant decrease was a positive baseline screening above 8 kPa to below 8 kPa at follow-up, with at least a 30% change,” Mr. Pustjens explained.
Their final analysis included 4,536 adults with a median liver stiffness score of 4.6 kPa; 4,285 (94.5%) were below 8 kPa at baseline and 251 (5.5%) were above 8 kPa; 2.4% had scores of 10 kPa or higher. Elevated alcohol consumption was present in 16% and body mass index was less than 25 kg/m2 in 29% of the study population, with 46% considered overweight and 25% obese.
The investigators found that 2.6% of individuals who screened negative at baseline experienced a clinically significant increase, and 1.4% increased to values above 10 kPa. Among those who screened positive at baseline, 44% experienced a clinically significant decrease in liver stiffness, while 8% experienced an increase in liver stiffness.
In a multivariable model adjusting for age, sex, study center, duration of follow-up, and liver stiffness at baseline, a BMI greater than 30 kg/m2 was heavily associated with a clinically significant increase in liver stiffness, Mr. Pustjens said.
“This was also true for increased alcohol consumption at baseline, presence of diabetes, and increased ALT [alanine aminotransferase]. But risk factors can also change over time,” he added. “In this study, weight gain was associated with an increased risk of liver stiffness progression, but this did not reach statistical significance.”
Likewise, progression from a normal serum glucose level at baseline to an abnormal/elevated serum glucose level at follow-up was associated with an increased risk for liver stiffness progression, as was an increase in ALT. Individuals with diabetes had approximately half the odds of a clinically significant liver stiffness regression.
“In summary, in this progressive, multicenter study, we found long-term liver stiffness screening in the general population to be feasible, with a participation rate of 80%,” Mr. Pustjens said. “Individuals with metabolic dysfunction, excessive alcohol use, [or] elevated transaminases or glucose should be prioritized for liver disease screening. Additionally, people living with diabetes [have] a lower probability of achieving a clinically significant decrease in liver stiffness.”
Vincent Chen, MD, an assistant professor of internal medicine at the University of Michigan Medical School, in Ann Arbor, noted that the conditions the researchers identified—diabetes, obesity, and high ALT—are known associations with severe liver disease and already are used as a basis for deciding whom to screen.
“This … study highlights how important it is for patients and medical providers to pay attention to those conditions,” he said.
“Doing VCTE in the entire population is probably not feasible now due to issues of access and cost,” he added. “Focusing our efforts and pre-screening with blood-based noninvasive tests in the right populations will be crucial.”
—Monica J. Smith
Dr. Chen and Mr. Pustjens reported no relevant financial disclosures.