Vibration-controlled transient elastography (VCTE)-based liver stiffness measurement (LSM) provides prognostic accuracy comparable to liver biopsy for predicting clinically meaningful liver outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD), according to results from a head-to-head comparison.

Reporting in Hepatology, corresponding author Laurent Castéra, MD, PhD, of the Department of Hepatology at Hopital Beaujon, Clichy, France, and colleagues noted that LSM obtained by VCTE has been shown to be strongly associated with liver-related events (LREs), although prior direct comparisons with liver histology have been constrained by limited sample sizes.

In a multi-center study, the researchers directly compared the ability of VCTE-derived LSM and liver biopsy to predict liver-related events (LREs) in patients with MASLD. They analyzed 3,532 adults with MASLD enrolled in the VCTE-Prognosis cohort, all of whom underwent both VCTE and liver biopsy at baseline. The primary outcome was incident LREs, defined as hepatic decompensation, liver transplantation, or liver-related death. Secondary outcomes included hepatic decompensation and hepatocellular carcinoma (HCC) assessed separately.

The mean age of the patients was 51.9 years and 57.3% were men. Median baseline LSM was 8.8 kPa, and one-third of patients had advanced fibrosis (F3–F4) on histology.

During a median follow-up of 56.6 months, 126 patients (3.6%) developed LREs, the vast majority driven by hepatic decompensation. LSM and histology demonstrated nearly identical prognostic performance for LRE prediction. Five-year area under the receiver operating characteristic curve (AUROC) values were 0.870 for LSM and 0.869 for histology, with comparable integrated AUROCs (0.878 vs 0.852), integrated precision–recall curves, and integrated Brier scores. No significant differences were observed using discrimination improvement metrics. Results were consistent across secondary outcomes, multiple time points, and sensitivity analyses.

According to the authors, LSM may be a practical alternative to histology as a surrogate prognostic endpoint in clinical trials and longitudinal risk stratification.

Source: Hepatology