Gastroenterology · Medical Literature
[Articles] Liver stiffness dynamics in European populations (LiverScreen): a longitudinal, multicentre, prospective, population-based cohort study
Abstract
Our findings suggest that repeated LSM screening in community-dwelling European populations is feasible. During long-term follow-up, there was a low incidence of clinically significant LSM increase, suggesting that screening should be targeted towards individuals at high risk, such as those with obesity, harmful alcohol use, type 2 diabetes, and elevated alanine aminotransferase levels. The high incidence of LSM decreases suggests that short-term confirmatory testing could be warranted.
Clinical relevance
In community-dwelling European adults without known liver disease, what are the long-term longitudinal dynamics of liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE), and which clinical risk factors predict clinically significant LSM changes? __SNAPSHOT__ {"studyDesign":"Longitudinal, multicentre, prospective, population-based cohort study (LiverScreen)","setting":"Three European cohorts: Barcelona, Spain (primary care setting); Odense, Denmark (population at risk of alcohol-related liver disease); Rotterdam, Netherlands (general population via the Rotterdam Study)","sampleSize":"n=7,884 with reliable baseline LSM; n=6,466 eligible for long-term follow-up after excluding those who died, relocated, or were unable to attend (1,418 excluded)","population":"Adults aged 18 years or older without known liver disease, recruited using random sampling strategies from three European populations between February 2, 2010, and October 1, 2021","intervention":"Repeated liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE), with collection of medical history, anthropometric measurements, and fasting blood samples at baseline and follow-up","comparator":"Not applicable (single-arm longitudinal cohort; baseline versus follow-up LSM compared within individuals)","primaryOutcome":"Two co-primary outcomes: (1) clinically significant LSM increase, defined as a rise from <8.0 kPa at baseline to ≥8.0 kPa at follow-up combined with a ≥30% change; and (2) clinically significant LSM decrease, defined as a fall from ≥8.0 kPa at baseline to <8.0 kPa at follow-up combined with a ≥30% change","followUp":"Baseline recruitment through October 1, 2021; last follow-up date September 4, 2024; minimum follow-up of 1 year per participant (exact median follow-up duration not reported in abstract)","fundingSource":"Government/non-profit: EU Horizon 2020 Research Innovation Programme"}
Key findings
The study enrolled 7,884 participants with reliable baseline LSM across three European cohorts, of whom 6,466 were eligible for long-term follow-up. The abstract reports a low incidence of clinically significant LSM increase (crossing from <8.0 kPa to ≥8.0 kPa with ≥30% change) during long-term follow-up, and a high incidence of clinically significant LSM decrease (crossing from ≥8.0 kPa to <8.0 kPa with ≥30% change). Exact incidence rates, hazard ratios, confidence intervals, and p-values for these primary outcomes are not reported in the abstract. Risk factors independently associated with clinically significant LSM increase included obesity, harmful alcohol use, type 2 diabetes, and elevated alanine aminotransferase (ALT) levels; specific effect sizes for these associations are not reported in the abstract. No adverse events were applicable given the observational design using non-invasive elastography. NNT/NNH are not calculable from the available data.
Practice implications
This study establishes the feasibility of repeated LSM-based liver fibrosis screening in community-dwelling European populations over long-term follow-up. Its principal actionable finding is that clinically significant LSM progression (below-to-above 8.0 kPa threshold with ≥30% change) was uncommon at the population level, suggesting that indiscriminate universal repeat screening of unselected adults is unlikely to be efficient or cost-effective. Instead, targeted repeat screening appears warranted in individuals with recognised metabolic and hepatic risk factors—specifically obesity, type 2 diabetes, harmful alcohol use, and elevated ALT—consistent with established liver fibrosis risk stratification frameworks. The observation of a high incidence of clinically significant LSM decrease has important implications: spontaneous or treatment-related improvement is common in this population-based setting, and a single elevated LSM reading should not prompt irreversible clinical decisions without short-term confirmatory re-testing. Notably, the study was conducted in three Northern and Southern European populations with heterogeneous recruitment strategies (primary care, alcohol-risk population, and general population), and generalisability to other ethnic groups, lower-income populations, or regions with different liver disease epidemiology is not established. Hard clinical endpoints (liver-related events, mortality) are not reported in the abstract; the primary outcomes rely on LSM threshold crossing as a surrogate marker of fibrosis progression/regression, which is subject to measurement variability inherent to transient elastography. As only the abstract is available for this summary, precise quantitative findings (incidence rates, multivariable model outputs, and subgroup data) cannot be fully appraised. __LIMITATIONS__ Only the abstract is available; key quantitative data including exact incidence rates, hazard ratios, confidence intervals, and p-values for primary outcomes cannot be independently verified or appraised.,Clinically significant LSM change is defined by a surrogate threshold (8.0 kPa crossing with ≥30% change) rather than histological fibrosis progression/regression or hard liver-related clinical events (e.g., decompensation, hepatocellular carcinoma, liver-related mortality).,The three cohorts used heterogeneous recruitment strategies (primary care, alcohol-risk enriched, and general population), introducing potential selection bias and limiting internal comparability across sites.,Participants who died, relocated, or were unable to attend follow-up (n=1,418; ~18%) were excluded from longitudinal analysis, creating potential survival and healthy-participant bias that may underestimate true progression incidence.,The minimum follow-up of 1 year may be insufficient to capture slow fibrosis progression in low-risk individuals; median follow-up duration is not reported in the abstract.,Generalisability is limited to adults of European descent; non-European populations and younger adults (<18 years) were not represented.,LSM by VCTE is subject to known measurement variability (body habitus, operator technique, fasting status), which may contribute to the high observed rate of LSM decreases, potentially reflecting regression to the mean rather than true biological improvement.,The study design does not permit causal inference regarding risk factor modification and LSM trajectory.,Funding by EU Horizon 2020 (public/non-profit) reduces commercial conflict-of-interest risk, though individual investigator relationships with elastography manufacturers (e.g., Echosens) are declared. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ In community-dwelling European adults, clinically significant liver stiffness progression was uncommon over long-term follow-up, supporting a risk-stratified rather than universal repeat screening approach—with priority given to individuals with obesity, type 2 diabetes, harmful alcohol use, or elevated ALT. The high rate of clinically significant LSM decrease observed reinforces the need for short-term confirmatory re-testing before acting on an initially elevated result. These findings are potentially practice-informing for screening programme design, but full appraisal of quantitative effect estimates and hard clinical outcomes requires access to the complete publication.