Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis

Konstantinos Ouranos; Mark Michael; Evangelia K. Mylona; Fadi Shehadeh; Markos Kalligeros; Margaret L.P. Teng; Mark D. Muthiah; Mohammad S. Siddiqui; Sudha Kodali; Tamneet Basra; Michelle Jones-Pauley; David W. Victor; Eleftherios Mylonakis; Mazen Noureddin; Kavish R. Patidar

doi:10.1016/j.cgh.2025.12.021

Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis

Konstantinos Ouranos, Mark Michael, Evangelia K. Mylona, Fadi Shehadeh, Markos Kalligeros, Margaret L.P. Teng, Mark D. Muthiah, Mohammad S. Siddiqui, Sudha Kodali, Tamneet Basra, Michelle Jones-Pauley, David W. Victor, Eleftherios Mylonakis, Mazen Noureddin, Kavish R. Patidar

Research output: Contribution to journal › Review article › peer-review

Abstract

BACKGROUND & AIMS: The prognostic value of dynamic liver stiffness measurement (LSM) changes via vibration-controlled transient elastography in predicting liver-related events (LREs) for patients with compensated advanced chronic liver disease (cACLD) and no-cACLD remains unclear.

METHODS: We conducted a systematic review and meta-analysis of observational studies evaluating LRE risk in patients with ACLD and multiple LSMs. Clinically significant LSM changes were defined as: cACLD progressors (follow-up LSM [fuLSM] ≥20% increase with baseline LSM [bLSM] ≥10 kPa); no cACLD progressors (fuLSM ≥10 kPa, bLSM <10 kPa); cACLD regressors (fuLSM <10 kPa with bLSM ≥10 kPa or fuLSM ≥20% decrease with fuLSM <20 kPa). Relative risks (RRs) with 95% confidence intervals (CIs) were calculated.

RESULTS: Analysis of 24,557 patients from 7 studies revealed significant associations between dynamic LSM changes and LRE risk after a median follow-up of 52.8 months. cACLD progressors showed higher, although not statistically significant, LRE risk vs non-progressors (17.9% vs 6.5%; RR, 1.64; 95% CI, 0.56-4.81). No-cACLD progressors demonstrated significantly increased LRE risk compared with non-progressors (5.7% vs 0.4%; RR, 6.02; 95% CI, 4.22-8.59). Conversely, cACLD regressors exhibited significantly reduced LRE risk vs non-regressors (2.2% vs 9%; RR, 0.18; 95% CI, 0.13-0.25). Subgroup analysis in metabolic dysfunction-associated steatotic liver disease revealed similar results.

CONCLUSIONS: Dynamic LSM changes in no-cACLD progressors and cACLD regressors are significantly associated with increased and decreased LRE risk, respectively. These findings highlight the potential of serial LSM measurements for monitoring chronic liver disease and for clinical trial endpoints. Prospective longitudinal studies are needed to evaluate if changes in LSM measurements over time are linked to improved patient outcomes.

Original language	English (US)
Pages (from-to)	1519-1528
Number of pages	10
Journal	Clinical Gastroenterology and Hepatology
Volume	24
Issue number	6
Early online date	Jan 12 2026
DOIs	https://doi.org/10.1016/j.cgh.2025.12.021
State	Published - Jun 2026

Keywords

Advanced Chronic Liver Disease
Liver Stiffness Measurement
Liver-related Events
MASH
MASLD
Liver/pathology
Vibration
Prognosis
Elasticity Imaging Techniques/methods
Humans
Liver Diseases/diagnosis

ASJC Scopus subject areas

Hepatology
Gastroenterology

Divisions

Gastroenterology and Hepatology
Infectious Disease

Access to Document

10.1016/j.cgh.2025.12.021

Cite this

Ouranos, K., Michael, M., Mylona, E. K., Shehadeh, F., Kalligeros, M., Teng, M. L. P., Muthiah, M. D., Siddiqui, M. S., Kodali, S., Basra, T., Jones-Pauley, M., Victor, D. W., Mylonakis, E., Noureddin, M., & Patidar, K. R. (2026). Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology, 24(6), 1519-1528. https://doi.org/10.1016/j.cgh.2025.12.021

Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis. / Ouranos, Konstantinos; Michael, Mark; Mylona, Evangelia K. et al.
In: Clinical Gastroenterology and Hepatology, Vol. 24, No. 6, 06.2026, p. 1519-1528.

Research output: Contribution to journal › Review article › peer-review

Ouranos, K, Michael, M, Mylona, EK, Shehadeh, F, Kalligeros, M, Teng, MLP, Muthiah, MD, Siddiqui, MS, Kodali, S, Basra, T, Jones-Pauley, M, Victor, DW , Mylonakis, E , Noureddin, M & Patidar, KR 2026, 'Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis', Clinical Gastroenterology and Hepatology, vol. 24, no. 6, pp. 1519-1528. https://doi.org/10.1016/j.cgh.2025.12.021

@article{5ee482e6740447d18f04b000c532efa8,

title = "Impact of 20\% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis",

abstract = "BACKGROUND \& AIMS: The prognostic value of dynamic liver stiffness measurement (LSM) changes via vibration-controlled transient elastography in predicting liver-related events (LREs) for patients with compensated advanced chronic liver disease (cACLD) and no-cACLD remains unclear.METHODS: We conducted a systematic review and meta-analysis of observational studies evaluating LRE risk in patients with ACLD and multiple LSMs. Clinically significant LSM changes were defined as: cACLD progressors (follow-up LSM [fuLSM] ≥20\% increase with baseline LSM [bLSM] ≥10 kPa); no cACLD progressors (fuLSM ≥10 kPa, bLSM <10 kPa); cACLD regressors (fuLSM <10 kPa with bLSM ≥10 kPa or fuLSM ≥20\% decrease with fuLSM <20 kPa). Relative risks (RRs) with 95\% confidence intervals (CIs) were calculated.RESULTS: Analysis of 24,557 patients from 7 studies revealed significant associations between dynamic LSM changes and LRE risk after a median follow-up of 52.8 months. cACLD progressors showed higher, although not statistically significant, LRE risk vs non-progressors (17.9\% vs 6.5\%; RR, 1.64; 95\% CI, 0.56-4.81). No-cACLD progressors demonstrated significantly increased LRE risk compared with non-progressors (5.7\% vs 0.4\%; RR, 6.02; 95\% CI, 4.22-8.59). Conversely, cACLD regressors exhibited significantly reduced LRE risk vs non-regressors (2.2\% vs 9\%; RR, 0.18; 95\% CI, 0.13-0.25). Subgroup analysis in metabolic dysfunction-associated steatotic liver disease revealed similar results.CONCLUSIONS: Dynamic LSM changes in no-cACLD progressors and cACLD regressors are significantly associated with increased and decreased LRE risk, respectively. These findings highlight the potential of serial LSM measurements for monitoring chronic liver disease and for clinical trial endpoints. Prospective longitudinal studies are needed to evaluate if changes in LSM measurements over time are linked to improved patient outcomes.",

keywords = "Advanced Chronic Liver Disease, Liver Stiffness Measurement, Liver-related Events, MASH, MASLD, Liver/pathology, Vibration, Prognosis, Elasticity Imaging Techniques/methods, Humans, Liver Diseases/diagnosis",

author = "Konstantinos Ouranos and Mark Michael and Mylona, \{Evangelia K.\} and Fadi Shehadeh and Markos Kalligeros and Teng, \{Margaret L.P.\} and Muthiah, \{Mark D.\} and Siddiqui, \{Mohammad S.\} and Sudha Kodali and Tamneet Basra and Michelle Jones-Pauley and Victor, \{David W.\} and Eleftherios Mylonakis and Mazen Noureddin and Patidar, \{Kavish R.\}",

year = "2026",

month = jun,

doi = "10.1016/j.cgh.2025.12.021",

language = "English (US)",

volume = "24",

pages = "1519--1528",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "6",

}

TY - JOUR

T1 - Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes

T2 - A Systematic Review and Meta-analysis

AU - Ouranos, Konstantinos

AU - Michael, Mark

AU - Mylona, Evangelia K.

AU - Shehadeh, Fadi

AU - Kalligeros, Markos

AU - Teng, Margaret L.P.

AU - Muthiah, Mark D.

AU - Siddiqui, Mohammad S.

AU - Kodali, Sudha

AU - Basra, Tamneet

AU - Jones-Pauley, Michelle

AU - Victor, David W.

AU - Mylonakis, Eleftherios

AU - Noureddin, Mazen

AU - Patidar, Kavish R.

PY - 2026/6

Y1 - 2026/6

N2 - BACKGROUND & AIMS: The prognostic value of dynamic liver stiffness measurement (LSM) changes via vibration-controlled transient elastography in predicting liver-related events (LREs) for patients with compensated advanced chronic liver disease (cACLD) and no-cACLD remains unclear.METHODS: We conducted a systematic review and meta-analysis of observational studies evaluating LRE risk in patients with ACLD and multiple LSMs. Clinically significant LSM changes were defined as: cACLD progressors (follow-up LSM [fuLSM] ≥20% increase with baseline LSM [bLSM] ≥10 kPa); no cACLD progressors (fuLSM ≥10 kPa, bLSM <10 kPa); cACLD regressors (fuLSM <10 kPa with bLSM ≥10 kPa or fuLSM ≥20% decrease with fuLSM <20 kPa). Relative risks (RRs) with 95% confidence intervals (CIs) were calculated.RESULTS: Analysis of 24,557 patients from 7 studies revealed significant associations between dynamic LSM changes and LRE risk after a median follow-up of 52.8 months. cACLD progressors showed higher, although not statistically significant, LRE risk vs non-progressors (17.9% vs 6.5%; RR, 1.64; 95% CI, 0.56-4.81). No-cACLD progressors demonstrated significantly increased LRE risk compared with non-progressors (5.7% vs 0.4%; RR, 6.02; 95% CI, 4.22-8.59). Conversely, cACLD regressors exhibited significantly reduced LRE risk vs non-regressors (2.2% vs 9%; RR, 0.18; 95% CI, 0.13-0.25). Subgroup analysis in metabolic dysfunction-associated steatotic liver disease revealed similar results.CONCLUSIONS: Dynamic LSM changes in no-cACLD progressors and cACLD regressors are significantly associated with increased and decreased LRE risk, respectively. These findings highlight the potential of serial LSM measurements for monitoring chronic liver disease and for clinical trial endpoints. Prospective longitudinal studies are needed to evaluate if changes in LSM measurements over time are linked to improved patient outcomes.

AB - BACKGROUND & AIMS: The prognostic value of dynamic liver stiffness measurement (LSM) changes via vibration-controlled transient elastography in predicting liver-related events (LREs) for patients with compensated advanced chronic liver disease (cACLD) and no-cACLD remains unclear.METHODS: We conducted a systematic review and meta-analysis of observational studies evaluating LRE risk in patients with ACLD and multiple LSMs. Clinically significant LSM changes were defined as: cACLD progressors (follow-up LSM [fuLSM] ≥20% increase with baseline LSM [bLSM] ≥10 kPa); no cACLD progressors (fuLSM ≥10 kPa, bLSM <10 kPa); cACLD regressors (fuLSM <10 kPa with bLSM ≥10 kPa or fuLSM ≥20% decrease with fuLSM <20 kPa). Relative risks (RRs) with 95% confidence intervals (CIs) were calculated.RESULTS: Analysis of 24,557 patients from 7 studies revealed significant associations between dynamic LSM changes and LRE risk after a median follow-up of 52.8 months. cACLD progressors showed higher, although not statistically significant, LRE risk vs non-progressors (17.9% vs 6.5%; RR, 1.64; 95% CI, 0.56-4.81). No-cACLD progressors demonstrated significantly increased LRE risk compared with non-progressors (5.7% vs 0.4%; RR, 6.02; 95% CI, 4.22-8.59). Conversely, cACLD regressors exhibited significantly reduced LRE risk vs non-regressors (2.2% vs 9%; RR, 0.18; 95% CI, 0.13-0.25). Subgroup analysis in metabolic dysfunction-associated steatotic liver disease revealed similar results.CONCLUSIONS: Dynamic LSM changes in no-cACLD progressors and cACLD regressors are significantly associated with increased and decreased LRE risk, respectively. These findings highlight the potential of serial LSM measurements for monitoring chronic liver disease and for clinical trial endpoints. Prospective longitudinal studies are needed to evaluate if changes in LSM measurements over time are linked to improved patient outcomes.

KW - Advanced Chronic Liver Disease

KW - Liver Stiffness Measurement

KW - Liver-related Events

KW - MASH

KW - MASLD

KW - Liver/pathology

KW - Vibration

KW - Prognosis

KW - Elasticity Imaging Techniques/methods

KW - Humans

KW - Liver Diseases/diagnosis

UR - https://www.scopus.com/pages/publications/105032237637

UR - https://www.scopus.com/inward/citedby.url?scp=105032237637&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2025.12.021

DO - 10.1016/j.cgh.2025.12.021

M3 - Review article

C2 - 41534760

AN - SCOPUS:105032237637

SN - 1542-3565

VL - 24

SP - 1519

EP - 1528

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 6

ER -

Impact of 20% Change in Vibration-controlled Transient Elastography-measured Liver Stiffness on Liver-related Outcomes: A Systematic Review and Meta-analysis

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