A large meta-analysis looked at whether changes in liver stiffness over time can predict future liver problems in people with chronic liver disease. The study combined data from 14 studies involving over 24,500 patients with compensated advanced chronic liver disease (cACLD) or without it. Liver stiffness was measured using a non-invasive ultrasound technique called vibration-controlled transient elastography (VCTE), which is like a gentle tap on the liver. Patients were followed for about 4.4 years on average.
In patients with cACLD, those whose liver stiffness increased over time (progressors) had a 64% higher chance of developing liver-related events compared to those whose stiffness did not increase. However, this result was not statistically significant, meaning it could be due to chance. In contrast, among patients without cACLD, progressors had a much higher risk—about 6 times higher—and this result was statistically significant. The actual rates of liver events were 17.9% in cACLD progressors versus 6.5% in non-progressors, and 5.7% in no-cACLD progressors versus 0.4% in non-progressors.
On the other hand, patients with cACLD whose liver stiffness decreased over time (regressors) had a much lower risk of liver events. Their risk was reduced by 82% compared to those whose stiffness did not decrease. The actual event rates were 2.2% in regressors versus 9% in non-regressors. This suggests that a decrease in liver stiffness may be a sign of improvement and lower risk.
These findings highlight the potential of using repeated liver stiffness measurements to monitor chronic liver disease and identify patients who may need closer follow-up or treatment. The results also suggest that changes in liver stiffness could be used as an endpoint in clinical trials for new treatments. However, the study has limitations: it included only observational studies, so it can show association but not cause and effect. Also, the result for cACLD progressors was not statistically significant, so more research is needed.
In summary, tracking liver stiffness over time can help predict who is at higher or lower risk for liver complications. Patients whose stiffness increases may need more aggressive management, while those whose stiffness decreases may be doing well. Future prospective studies are needed to confirm these findings and to see if using stiffness changes to guide treatment actually improves patient outcomes.