Cirrhosis is the end stage of a number of chronic liver diseases, including non-alcoholic steatohepatitis (NASH). Characterised by the scarring of liver tissue, cirrhosis leads to significant hepatic tissue distortion, which may subsequently cause portal hypertension, hepatic synthetic dysfunction, and hepatocellular carcinoma. Despite the existence of such associations, the clinical benefits of cirrhosis regression (≥1‐stage improvement in fibrosis) in NASH remain unknown.
The aim of this article was to assess the link between histological and non-invasive tests (NITs) of fibrosis and liver-related complications in patients with cirrhotic NASH.
Cirrhosis regression was found to be strongly associated with changes in fibrosis assessments. These included NITs such as enhanced liver fibrosis (ELF) scores and liver stiffness measurements acquired using vibration‐controlled transient elastography (VCTE). In patients with NASH-induced compensated cirrhosis, attenuation of fibrosis (i.e., cirrhosis regression) was associated with a 6-fold reduction in the risk of cirrhosis-related events. These findings support the use of fibrosis regression measured histologically and with NITs as a clinical trial endpoint for cirrhotic NASH.