Liver stiffness thresholds may be valuable for risk stratification of NASH people with advanced fibrosis

According to a study, individuals with severe fibrosis who have non-alcoholic steatohepatitis (NASH) may benefit from using liver stiffness criteria for risk classification. Investigators aimed to define thresholds for liver stiffness using vibration-controlled transient elastography (VCTE) that predict cirrhosis progression in people with bridging fibrosis and anticipate hepatic decompensation in people with cirrhosis triggered by NASH.

Data from four randomized placebo-controlled trials of Simtuzumab and Selonsertib in subjects with advanced fibrosis (F3-F4) was analyzed. Due to lack of effectiveness, the studies were discontinued. Central staging of liver fibrosis was performed at baseline, week 48 (Selonsertib trial), and week 96 (Simtuzumab study). Cox proportional hazards regression analysis was utilized to examine the relationships between liver stiffness as measured by VCTE with disease progression.

Notably, 103 out of 664 patients (16%) with bridging fibrosis progressed to cirrhosis, while 27 out of 734 patients (4%) with baseline cirrhosis experienced adjudicated liver-related events. The best baseline liver stiffness thresholds were ≥16.6 kPa for predicting cirrhosis development and ≥30.7 kPa for predicting events related to the liver.

In people with bridging fibrosis, baseline liver stiffness ≥16.6 kPa (adjusted HR 3.99) and a ≥5 kPa (and ≥20%) rise (adjusted HR 1.98) were independent predictors of cirrhosis advancement, whereas baseline liver stiffness ≥30.7 kPa (adjusted HR 10.13) anticipated liver-associated events in cirrhosis patients. The criteria for liver stiffness might be helpful for the risk classification of NASH patients with advanced fibrosis.