Gastroenterology · Medical Literature
[Comment] Effect of repeated elastography measurements in LiverScreen
Abstract
Liver disease is increasingly prevalent in the general population, with metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) being especially common.1,2 Nevertheless, only about 3% of patients with MASLD have progression to major adverse liver outcomes, such as decompensated cirrhosis or hepatocellular carcinoma within 20 years of diagnosis.3 Whether MASLD without fibrosis should be considered a disease or a risk factor is an ongoing discussion.
Clinical relevance
In community-dwelling European adults, what are the long-term dynamics of liver stiffness measurements (LSM) on repeated elastography screening, and which patient characteristics are associated with clinically significant changes in LSM over time? __SNAPSHOT__ {"studyDesign":"Editorial Comment accompanying a longitudinal, multicentre, prospective, population-based cohort study (the LiverScreen longitudinal study). The referenced primary study is a prospective cohort study.","setting":"Three European cohorts: Barcelona (primary care settings, Spain), Odense (population at risk for alcohol-related liver disease, Denmark), and Rotterdam (general population cohort, the Rotterdam Study, Netherlands).","sampleSize":"Not reported in the Comment abstract. The primary LiverScreen longitudinal cohort enrolled participants from three European sites; full n not extractable from the Comment alone.","population":"Community-dwelling adults aged 18 years or older, recruited using random sampling strategies, drawn from the general population and primary care settings across Europe. The broader LiverScreen project enrolled participants aged ≥40 years without known liver disease.","intervention":"Repeated liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) at longitudinal follow-up visits, with the aim of examining LSM dynamics and identifying risk factors for clinically significant changes.","comparator":"Within-person longitudinal comparison across repeated LSM assessments; no distinct external control group.","primaryOutcome":"Incidence of clinically significant LSM increase (and decrease) over long-term follow-up, and identification of risk factors associated with those changes.","followUp":"Described as 'long-term' in the primary study conclusion; exact duration not reported in the Comment abstract.","fundingSource":"European Union Horizon 2020 Research and Innovation Programme (grant agreement no. 847989), as reported for the LiverScreen project."}
Key findings
Based solely on the accompanying Comment abstract provided and conclusions reported from the primary LiverScreen longitudinal study: repeated LSM screening in community-dwelling European populations was found to be feasible. The incidence of clinically significant LSM increase during long-term follow-up was reported as low. Conversely, a high incidence of LSM decreases was observed, which the authors note may suggest that short-term confirmatory testing is warranted following an elevated initial screen. Risk factors identified as associated with clinically significant LSM increase included obesity, harmful alcohol use, type 2 diabetes, and elevated alanine aminotransferase (ALT) levels. No specific absolute or relative effect sizes, confidence intervals, hazard ratios, or p-values were reported in the Comment abstract or are derivable from the information provided. NNT/NNH cannot be calculated. Specific adverse event data were not applicable or reported in this observational context.
Practice implications
This Comment contextualizes the LiverScreen longitudinal cohort findings within the ongoing debate about population-level liver disease screening. The primary study established that repeated elastography-based LSM screening is operationally feasible in general European populations, and that clinically significant LSM progression is infrequent at a population level, supporting a risk-targeted rather than universal repeat-screening approach. A critical and clinically actionable observation is the high rate of LSM decreases on repeat testing, raising concern for false-positive screening results on single-measurement screens—a finding consistent with known within-subject variability of VCTE (pooled relative repeatability coefficients for VCTE LSM have been reported as substantially higher than for MRI-based measures in the MASLD monitoring literature). The Comment does not establish that screening reduces hard clinical endpoints (decompensated cirrhosis, hepatocellular carcinoma, or liver-related mortality), and the population studied (European community-dwelling adults) may not be fully generalizable to non-European, lower-income, or ethnically diverse populations. MASLD without fibrosis was explicitly framed as a condition of uncertain disease status versus risk factor status, and the Comment notes that only approximately 3% of MASLD patients progress to major adverse liver outcomes within 20 years—a critical context for calibrating screening intensity. Caution is warranted: this summary is based only on the provided Comment abstract and publicly available conclusions of the primary study abstract, not the full dataset. __LIMITATIONS__ Only the Comment abstract was provided; full primary study data, including sample sizes, precise follow-up durations, effect sizes, confidence intervals, and statistical testing details, are not available for review and cannot be independently verified.,The Comment is an editorial opinion piece, not an original research report; it does not present primary data and its conclusions reflect the authors' interpretation of the LiverScreen longitudinal study.,The primary cohorts are drawn from three European countries (Spain, Denmark, Netherlands), limiting generalizability to non-European or ethnically diverse populations.,VCTE-based LSM has well-documented biological and technical variability; the high observed rate of LSM decreases on repeat testing may partly reflect measurement imprecision rather than true biological regression of fibrosis.,The study used surrogate endpoints (LSM values) rather than hard liver-related clinical outcomes (e.g., decompensation, hepatocellular carcinoma, transplantation, or mortality), limiting conclusions about clinical benefit of repeated screening.,Ascertainment and definition of 'clinically significant' LSM change are not specified in the Comment abstract, making it difficult to assess threshold appropriateness.,Selection bias is possible in all three cohorts given their distinct recruitment strategies (primary care, alcohol-risk populations, general population registry), which may not reflect the full spectrum of community liver disease burden.,The Comment does not address cost-effectiveness, patient-reported outcomes, or harms of repeated screening (e.g., anxiety, downstream investigation burden).,Potential confounding by lifestyle changes (weight loss, alcohol reduction) between screening intervals that could independently influence LSM is not addressed in the Comment. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ The LiverScreen longitudinal data, as interpreted in this Comment, suggest that population-wide repeated LSM screening is feasible but that clinically significant fibrosis progression is uncommon in unselected European community adults, arguing for targeted screening in high-risk individuals (obesity, type 2 diabetes, harmful alcohol use, elevated ALT). The high rate of LSM decreases on repeat testing underscores the need for short-term confirmatory elastography before initiating further diagnostic workup or management changes based on a single elevated screen. Given that this summary is based on a Comment abstract only, clinicians should review the full primary LiverScreen longitudinal publication before applying these findings to practice.