Liver Elastography for Prognostication and Monitoring Patients With Compensated Advanced Chronic Liver Disease

Recent evidence indicates that liver stiffness measurement (LSM) by transient elastography can be used to predict decompensation and liver-related mortality with good prognostic accuracy. The relative risk of decompensation and death increases substantially from 10 to 25 kPa, after which it wanes off, when other prognostic factors become more important. It is thereby possible to use a rule-of-five to denote increasingly higher relative risks of outcomes related to portal hypertension: 10, 15, 20, and 25 kPa. Evidence also accumulates for the role of liver stiffness as a monitoring tool, with three major causes for repeating the index LSM: First, in patients with LSM 7–9.9 kPa, where cACLD can be ruled out, but the patient should be monitored on a case-by-case basis for progression. Second, in patients with LSM ≥ 10 kPa, where the index measurement should be validated to control for false positives. Third, in the management of cACLD patients, where LSM is monitored to guide decision-making during outpatient care and assess the effect of interventions on prognosis.