Clinical predictors of increased liver stiffness over time in metabolic dysfunction-associated steatotic liver disease: a prospective real-life study
(2026) EASL congress — Location: Barcelone (27.May.2026)
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- Background and aims: Static measurements of liver stiffness (LS) assessed by transient elastography are mainly used in routine practice to evaluate MASLD, whereas dynamic data are lacking. Here, we wanted to evaluate LS dynamics to reflect the evolution of MASLD. Method: Patients with MASLD assessed with standardised serial LS from baseline diagnostic and at one- and three-year follow-ups (FU) were prospectively included. They were classified as progressors (PRO, ≥ 20 % LS increase compared to baseline), stable (STB, < 20 % of LS variations) and improvers (IMP, ≥ 20 % LS decrease compared to baseline). Results: 192 patients diagnosed with MASLD were included. At baseline, 57 % were F0-F1, 38 % F2-F3 and 5 % F4. 36 % were treated for type 2 diabetes. Initial management included lifestyle advice (74 %), dietitian support (8 %), interventional clinical trial (7 %), bariatric surgery (6 %) and glucagon-like peptide-1 receptor agonist (GLP1-RA, 3 %). After one year (n = 192), 30 % were IMP, 47 % were STB and 23 % were PRO. IMP at one-year were characterised at baseline by a higher body mass index (IMP, median, 32.0 vs. STB, 30.5 vs. PRO, 30.9 kg/m²; p = 0.027), a larger waist circumference (115 vs. 107 vs. 107 cm; p = 0.002) and a higher LS (8.9 vs. 6.3 vs. 5.0 kPa; p < 0.001). Moreover, IMP had a greater reduction than PRO in body weight (BW, -5 vs. 0 %; p < 0.001), alanine aminotransferase (-34 vs. -8 %; p = 0.004), gamma-glutamyl transferase (-25 vs. -5 %; p = 0.032) and controlled attenuation parameter (-7 vs. -2 %; p = 0.045). In multivariate logistic regression, after adjustment for sex and BMI, higher baseline age (OR = 1.052; p = 0.012) and ALT (OR = 1.027; p < 0.006), and increase in BW (OR = 1.107; p = 0.019) and ALT (OR = 1.012; p = 0.025) were independent predictors of being PRO after one year of FU. After three years (n = 134), the proportion of patients in the three groups remained similar (IMP 34 %; STB 42 %; PRO 25 %) with comparable characteristics. Conclusion: This is the first prospective data on standardised longitudinal LS in real-life conditions within a MASLD cohort. Screening for advanced fibrosis leads to effective and sustainable lifestyle advice with a positive impact on the severity of liver disease. While around 40 % of patients remain stable at one and three years, with normal baseline LS, older patients with low LS, elevated ALT who gain weight and increase their ALT levels over time should be monitored.
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André-Dumont, S., Scholtens, J., & Lanthier, N. (2026). Clinical predictors of increased liver stiffness over time in metabolic dysfunction-associated steatotic liver disease: a prospective real-life study. Journal of Hepatology, 84S1(S69-S981), S541. https://doi.org/10.1016/S0168-8278(26)01554-0 (Original work published 2026)