Prognostic significance of liver stiffness in patients with primary biliary cholangitis: validation of Baveno VII criteria

Background The role of liver stiffness measurements (LSM) in patients with primary biliary cholangitis (PBC) remains to be further elucidated. Aims To clarify the prognostic role of LSM and to validate the “novel concepts” proposed by the Baveno VII Working Group. Methods An analysis of the prognostic significance of LSM was performed involving 672 patients. Results LSM and ΔLSM/ΔT were independent risk factors for liver decompensation, liver transplantation, or liver-related death (primary outcomes, p < 0.001, both). A rule of 5 kPa for LSM (10–15–20 kPa) could be used to denote progressively higher relative risks of primary outcomes. Patients with LSM < 10 kPa have a negligible 3-year risk of primary outcomes (< 1%). Cut-off values of 10 and 15 kPa can be used to classify PBC patients into low-, medium-, and high-risk groups. A clinically significant decrease in LSM, evaluated at 6, 12, or 24 months elastography tests, was associated with a substantially reduced risk of primary outcomes ( p < 0.05, all), which can be defined as a decrease in LSM of > − 20% associated with LSM < 20 kPa or any decrease to LSM < 10 kPa. A clinically significant increase in LSM, evaluated at 6, 12, or 24 months elastography tests, was associated with a substantially raised risk of primary outcomes ( p < 0.05, all), which can be defined as an increase in LSM of ≥ + 20% or any increase to LSM ≥ 15 kPa. Conclusions LSM can be used to monitor disease progression and predict long-term prognosis in patients with PBC.