Interpretation of liver stiffness measurement in patients with mixed liver disease etiologies

Theodor Bilharz Research Institute

Bibliographic Information

Authors: El Ray A.; El Ghannam M.; Rautou P.E.

Journal: Arab Journal of Gastroenterology

Publisher: Elsevier Ltd

Publication Date: August 2026

ISSN: 16871979

DOI: 10.1016/j.ajg.2026.05.002

Scopus: View on Scopus

PubMed: 42362465

Document Type: Letter

Authors and Affiliations

El Ray A., Theodor Bilharz Research Institute, Hepatogastroenterology Department, Giza, Egypt, Faculty of Medicine, October 6 University, Egypt; El Ghannam M., Theodor Bilharz Research Institute, Hepatogastroenterology Department, Giza, Egypt; Rautou P.E., Université Paris-Cité, Inserm, Centre de recherche sur l’inflammation, UMR 1149, Paris, France, AP-HP, Hôpital Beaujon, Service d’Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France

Abstract

Vibration-controlled transient elastography (VCTE)–based liver stiffness measurement (LSM) is widely used for non-invasive assessment of liver fibrosis and portal hypertension in chronic liver disease. In daily practice, LSM values are often interpreted using etiology-specific fibrosis cut-offs embedded in device software. However, an increasing proportion of patients now present with mixed liver disease etiologies, particularly combinations of metabolic-associated steatotic liver disease (MASLD) with viral or alcohol-related liver disease. In such patients, applying singleetiology cut-offs may lead to misclassification of fibrosis stage and portal hypertension risk. We highlight the limitations of this approach and argue that LSM should be interpreted within a broader clinical context, integrating platelet count, biochemical markers, and validated risk-stratification algorithms rather than relying solely on fibrosis staging tables. Pan-Arab Association of Gastroenterology

Keywords

Baveno VII; Compensated advanced chronic liver disease; Liver stiffness; Mixed liver disease etiologies; Vibration-controlled transient elastography; Biomarkers; Elasticity Imaging Techniques; Fatty Liver; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Liver Diseases; Platelet Count; biochemical marker; biological marker; algorithm; chronic liver disease; human; Letter; probability; risk; transient elastography; vibration; blood; complication; diagnostic imaging; elastography; etiology; liver disease; pathology; portal hypertension; procedures

Citation Information

Scopus Citations: 0

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