Head-to-head comparison between vibration-controlled transient elastography and histology in predicting liver-related events due to metabolic dysfunction-associated steatotic liver disease

Year: 2025

Type: article

Abstract: BACKGROUND AND AIMS: Liver stiffness measurement (LSM) by vibration-controlled transient elastography correlates well with liver-related events (LREs), but previous head-to-head comparisons with liver histology were limited by small sample size. This study aimed to compare the prognostic performance of LSM and histology for predicting LREs in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). APPROACH AND RESULTS: We analyzed data from 3532 metabolic dysfunction-associated steatotic liver disease patients (mean age 51.9 y, 57.3% male) in the multicenter vibration-controlled transient elastography-prognosis cohort, all having undergone both LSM and liver biopsy. The primary outcome was LREs, defined as hepatic decompensation, liver transplantation, or liver-related death. Secondary outcomes included HCC and decompensation analyzed separately. Median baseline LSM was 8.8 kPa; 33.5% had F3-F4 fibrosis. Over a median follow-up of 56.6 months, 126 patients (3.6%) developed LREs (123 decompensation). LSM and histology demonstrated similar prognostic performance for LREs, with comparable 5-year AUROC values (0.870 vs. 0.869), integrated AUROCs (0.878 vs. 0.852), and integrated precision-recall curves (0.137 vs. 0.0.68). The 5-year integrated Brier scores were also similar (1.389% vs. 1.391%), and the integrated discrimination improvement index showed no significant difference. Similar results were found across all the outcomes, time points, and sensitivity analyses. CONCLUSIONS: In this large metabolic dysfunction-associated steatotic liver disease cohort, LSM by vibration-controlled transient elastography showed comparable prognostic accuracy to histology. As a noninvasive tool, LSM may serve as an alternative surrogate endpoint in clinical trials.

Source: Hepatology

DOI: 10.1097/hep.0000000000001658

Institutions: Chinese University of Hong Kong, Yonsei University, Yonsei University Health System, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, The Royal Free Hospital, University College London, University of Palermo, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Turin, Yokohama City University, Wenzhou Medical University, First Affiliated Hospital of Wenzhou Medical University, Karolinska University Hospital, Karolinska Institutet, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Singapore General Hospital, University of Malaya, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Virginia Commonwealth University, Echosens (France), King's College London, Foundation for Liver Research, King's College Hospital, XinHua Hospital, Beth Israel Deaconess Medical Center, Harvard University, University Hospitals Birmingham NHS Foundation Trust, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Inserm, Université Paris Cité, Hôpital Beaujon, Assistance Publique – Hôpitaux de Paris, Centre de Recherche sur l'Inflammation

Language: English

Topic: Liver Disease Diagnosis and Treatment

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: Eli Lilly and Company, Pfizer, AstraZeneca, Gilead Sciences, EA Pharma Co., Ltd., Kowa Company, Children's Liver Disease Foundation, Novo Nordisk, Chinese University of Hong Kong, Astellas Pharma, Ipsen, National Science and Technology Major Project, UCB Pharma

Awards: G2861277680, G6540745682

OpenAlex ID: W7117296271