ArticleJournal of hepatology2021
Prognostic performance of 7 biomarkers compared to liver biopsy in early alcohol-related liver disease.
Article in Journal of hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 2 of them syntheses that pooled it.
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Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it, 134 citations in OpenAlex.
- KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease.Clinical and molecular hepatology · 2024Guideline
- CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF PORTAL HYPERTENSION.Acta clinica Croatica · 2024Guideline
- Evaluating periportal fibrosis in schistosomiasis mansoni using the ELF [Enhanced Liver Fibrosis] score: A pilot study.PLoS neglected tropical diseases · 2026Article
- Cardiovascular and hepatic outcomes: prognostic differences across MASLD-MetALD-ALD continuum.Clinical and molecular hepatology · 2026Review
- Steatotic liver disease: non-invasive assessment and biomarkers across metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatotic liver disease with moderate alcohol consumption and alcohol-associated liver disease.Clinical and molecular hepatology · 2026Review
- The dynamic spectrum of steatotic liver disease: the global perspective.Nature reviews. Gastroenterology & hepatology · 2026Review
- High incidence of advanced liver disease and mortality in patients presenting with alcohol use disorder.Hepatology communications · 2026Article
- Enhanced Liver Fibrosis Test, FIB-4 and FibroScan: Real-World Prognostic Accuracy for MASLD in a Biopsy-Controlled Cohort.Liver international : official journal of the International Association for the Study of the Liver · 2026Observational
- Alcohol-related liver disease disrupts bile acid homeostasis and gut microbial bile acid metabolism.JHEP reports : innovation in hepatology · 2026Article
- The diagnostic value of MRE in patients with decompensated cirrhosis: comparing it to Gd-EOB-DTPA-enhanced MRI.BMC medical imaging · 2026Article
- Prognostication of Liver Disease Patients via the WFUMB 'Rule-of-4' Algorithm Using SSI-2D-SWE-Based Liver Stiffness Measurement.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Noninvasive Tests for Predicting Decompensation in Compensated Advanced Chronic Liver Disease: A Comprehensive Review.Liver international : official journal of the International Association for the Study of the Liver · 2026Review
- Novel biomarkers for alcohol-associated liver disease and their implications across clinical settings.Clinical and molecular hepatology · 2026Review
- Fibrosis activityJHEP reports : innovation in hepatology · 2026Article
- Alcohol Use Disorder With Metabolic Dysfunction Is Associated With Adverse Health Impacts in a United States Clinical Setting.Addiction biology · 2026Article
- Risk factors for significant hepatic fibrosis in alcoholic liver disease and construction of a nomogram prediction model.BMC gastroenterology · 2026Article
- Reducing alcohol-associated liver disease burden in the general population.The lancet. Gastroenterology & hepatology · 2025Review
- Non-invasive tests for MetALD and alcohol-related liver disease.JHEP reports : innovation in hepatology · 2025Review
- Diagnosis of Portal Hypertension.Diagnostics (Basel, Switzerland) · 2025Review
- Oncogenic cholesterol rewires lipid metabolism in hepatocellular carcinoma via the CSNK2A1-IGF2R Ser2484 axis.Journal of advanced research · 2025Article
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsAlcohol is the most common cause of liver-related mortality and morbidity. We therefore aimed to assess and compare the prognostic performance of elastography and blood-based markers to predict time to the first liver-related event, severe infection, and all-cause mortality in patients with a history of excess drinking.
methodsWe performed a prospective cohort study in patients with early, compensated alcohol-related liver disease. At baseline, we obtained a liver biopsy, transient elastography (TE), 2-dimensional shear-wave elastography (2D-SWE), enhanced liver fibrosis test (ELF), FibroTest, fibrosis-4 index (FIB-4), non-alcoholic fatty liver fibrosis score (NFS) and Forns index. We compared C-statistics and time-dependent AUC for prognostication. We used validated cut-off points to create 3 risk groups for each test: low, intermediate and high risk.
resultsWe followed 462 patients for a median of 49 months (IQR 31-70). Median age was 57 years, 76% were males, 20% had advanced fibrosis. Eighty-four patients (18%) developed a liver-related event after a median of 18 months (7-34). TE had the highest prognostic accuracy, with a C-statistic of 0.876, and time-dependent AUC at 5 years of 0.889, comparable to 2D-SWE and ELF. TE, ELF and 2D-SWE outperformed FibroTest, FIB4, NFS, Forns index and biopsy-verified fibrosis stage. Compared to patients with TE <10 kPa, the hazard ratios for liver-related events for TE 10-15 kPa were 8.1 (3.2-20.4), and 27.9 (13.8-56.8) for TE >15 kPa. Periods of excessive drinking during follow-up increased the risk of progressing to liver-related events, except for patients in the low-risk groups.
conclusionTE, ELF and 2D-SWE are highly accurate prognostic markers in patients with alcohol-related liver disease. Easy-to-use cut-offs can distinguish between substantially different risk profiles. LAY SUMMARY: Alcohol is the leading cause of death and illness due to liver disease. In this study, we assessed the ability of biomarkers to predict the risk of developing symptomatic liver disease in patients with early stages of alcohol-related liver disease. We found that several tests accurately predicted the risk of liver-related events such as ascites, esophageal varices and hepatic encephalopathy during an average follow-up of 4.1 years. Liver stiffness measurements by ultrasound elastography and the enhanced liver fibrosis test performed best. By using them, we were able to stratify patients into 3 groups with significantly different risks.
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