The associations between fibrosis changes and liver‐related events in patients with metabolic dysfunction‐associated steatotic liver disease

Background The prognosis of metabolic dysfunction‐associated steatotic liver disease (MASLD) is associated with liver fibrosis. We investigated the associations between changes in liver stiffness measurement (LSM) over 3‐year period and the development of cirrhosis or hepatocellular carcinoma (HCC) in patients with MASLD. Methods This study involved patients with MASLD who underwent transient elastography at baseline and 3 years after baseline from 2012 to 2020. Low (L), indeterminate (I) and high (H) LSM values were classified as <8 kPa, 8–12 kPa and >12 kPa respectively. Results Among 1738 patients, 150 (8.6%) were diagnosed with cirrhosis or HCC. The proportions of patients with L, I and H risk were 69.7%, 19.9% and 10.5% at baseline, and 78.8%, 12.8% and 8.4% at 3 years after baseline, respectively. The incidence rates of cirrhosis or HCC per 1000 person‐years were 3.7 (95% confidence interval [CI], 2.4–5.5) in the L → L + I group, 23.9 (95% CI, 17.1–32.6) in the I → L + I group, 38.3 (95% CI, 22.3–61.3) in the H → L + I group, 62.5 (95% CI, 32.3–109.2) in the I → H group, 67.8 (95% CI, 18.5–173.6) in the L → H group and 93.9 (95% CI 70.1–123.1) in the H → H group. Two risk factors for the development of cirrhosis or HCC were LSM changes and low platelet counts. Conclusion LSM changes could predict clinical outcomes in patients with MASLD. Thus, it is important to monitor changes in the fibrotic burden by regular assessment of LSM values.