S2-E52.2 - How Liver Stiffness Measures Can Improve Practical Patient Management

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Alina Allen and Ian Rowe discuss how Liver Stiffness Measurements (LSM) can improve individual patient treatment in pre-cirrhotic and compensated cirrhotic patients. Their comments stem from Alina's presentation of the recent Mayo Clinic paper, "MRE for Prediction of Long-Term Progression and Outcome in Chronic Liver Disease: A Retrospective Study." In this conversation, Alina summarizes the paper, after which Stephen Harrison asks questions about availability of subgroup analysis.

Ian starts this section by noting the challenges in relying on fibrosis when managing individual patients practically and wonders whether LSM might do a better job here. Alina endorses this thought emphatically. She notes that while there may be a benefit in clinical trials to separate an F2 from an F3, F levels have minimal impact on clinical recommendations for pre-cirrhotic patients. Conversely, LSM provides guidance on how quickly a patient is progressing toward cirrhosis regardless of fibrosis level, which can affect aggressiveness of recommendations and frequency of monitoring, among other issues.

During this conversation, Ian shares that he is conducting community-based research with over 3,000 patients so far in Leeds. This study is revealing similar results, with liver stiffness predicting progression up to a "tipping point" at which liver function begins to matter more. This can become germane to any specialist or primary care physician when treating patients.

Toward the end of the conversation, Louise Campbell notes that these same metrics can help identify patients who are failing sooner, which will leave more time for compassionate palliative care and end of life planning.