AT A GLANCE

A new study published in the Journal of Hepatology concludes that referring to the current liver stiffness measurement (LSM) (LSMc) is best when estimating first hepatic decompensation (HD).¹

“Both LSM and biochemical response have prognostic significance in patients with primary biliary cholangitis (PBC),” explain study authors Wong et al. “However, the clinical relevance and how discordant biochemical and LSM changes should be best interpreted remain unclear.”

“We aim to determine the performance of the most recent or LSMc in predicting first HD in the setting of discordant biochemical and LSM responses.”

Patients with at least two reliable LSMs performed at least 6 months apart were included for analysis. For study purposes, LSM response was defined as stable or any reduction in LSM, while biochemical response was assessed using the Paris-2 criteria. The primary outcome of interest was the occurrence of the first HD, while secondary outcomes included LT and liver-related death.

According to the authors, over a median follow-up of 22 (IQR: 12-39) months, 3.3% of the total 1,793 PBC patients developed HD, while up to 55% of PBC patients exhibited discordance between their LSM and biochemical response.

Among patients with LSM response, meeting the Paris-2 criteria was associated with a reduced risk of HD. LSM response did not influence the risk of developing HD among patients with a biochemical response. Meanwhile, LSMc >10 kPa strongly predicted HD, irrespective of the biochemical response and prior LSM trajectory.

“Discordance between LSM and biochemical response is frequent. Most recent or current LSM is the strongest predictor of first liver-related events in patients with PBC, irrespective of prior biochemical response or LSM trajectory,” conclude the authors. “In this large international multicenter study, we demonstrated that, once the current LSM (LSMc) is known, prior LSM trajectories and biochemical changes did not improve the prediction of liver-related events in patients with PBC.”

Reference

1.     Wong YJ, Lam L, Soret P-A, et al. Prognostic value of liver stiffness measurement vs. biochemical response in primary biliary cholangitis (online ahead of print October 3, 2025). J Hepatol.