COMMENT:
Importantly, the association between increasing baseline LS-VCTE and risk of disease progression in NASH patients has been underscored by retrospective studies. Despite this, prospective data for cohorts with confirmed advanced fibrosis is scarce, and the ideal LS thresholds able to effectively predict fibrosis progression and decompensation remain undefined.
This study aimed to define thresholds for LS-VCTE that capably predict disease progression and clinical outcomes in patients with NASH-associated bridging fibrosis (F3) and cirrhosis.
Key learnings:
A baseline LS threshold ≥16.6 kPa accurately predicted progression to cirrhosis in patients with bridging fibrosis. Its c-statistic of 0.72 indicated good prognostic performance and discriminatory ability. Moreover, after adjusting for confounders, this threshold was found to be associated with a four-fold higher risk of progression to cirrhosis during follow-up. Among patients with bridging fibrosis at baseline, a ≥5kPa (and ≥20%) increase in LS-VCTE was linked with higher risks of progressing to cirrhosis. Similarly, the optimal baseline LS threshold for predicting liver-related events was ≥30.7 kPa in cirrhotic patients, with a corresponding c-statistic of 0.77. After adjusting for confounders, this threshold was found to be linked with a ten-fold higher risk of liver-related events. These thresholds hold significant value in risk stratification for patients with fibrosis in both clinical practice and NASH trials.
