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

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.