The associations between fibrosis changes and liver-related events in patients with metabolic dysfunction-associated steatotic liver disease

Background: The prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with liver fibrosis. We investigated the associations between changes in liver stiffness measurement (LSM) over 3-year period and the development of cirrhosis or hepatocellular carcinoma (HCC) in patients with MASLD. Methods: This study involved patients with MASLD who underwent transient elastography at baseline and 3 years after baseline from 2012 to 2020. Low (L), indeterminate (I) and high (H) LSM values were classified as <8 kPa, 8-12 kPa and >12 kPa respectively. Results: Among 1738 patients, 150 (8.6%) were diagnosed with cirrhosis or HCC. The proportions of patients with L, I and H risk were 69.7%, 19.9% and 10.5% at baseline, and 78.8%, 12.8% and 8.4% at 3 years after baseline, respectively. The incidence rates of cirrhosis or HCC per 1000 person-years were 3.7 (95% confidence interval [CI], 2.4-5.5) in the L -> L + I group, 23.9 (95% CI, 17.1-32.6) in the I -> L + I group, 38.3 (95% CI, 22.3-61.3) in the H -> L + I group, 62.5 (95% CI, 32.3-109.2) in the I -> H group, 67.8 (95% CI, 18.5-173.6) in the L -> H group and 93.9 (95% CI 70.1-123.1) in the H -> H group. Two risk factors for the development of cirrhosis or HCC were LSM changes and low platelet counts. Conclusion: LSM changes could predict clinical outcomes in patients with MASLD. Thus, it is important to monitor changes in the fibrotic burden by regular assessment of LSM values.