High Prevalence of Undiagnosed Liver Fibrosis in General Population

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European study had more than 30,000 people

by
Mike Bassett, Staff Writer, MedPage Today
May 11, 2025 • 3 min read

A significant number of people had asymptomatic liver disease, according to a large-scale European study.

The LIVERSCREEN study is assessing a feasible, non-invasive screening strategy for liver fibrosis detection in the general population, using serological tests and vibration-controlled transient elastography (VCTE).

In the study population of more than 30,000 people without known liver disease, the proportion of persons with a liver stiffness measurement (LSM) of ≥8 kilospascals (kPa) — a cut-off suggesting clinically relevant liver fibrosis — was 4.6%, reported Isabel Graupera, MD, PhD, of the Universidad de Barcelona in Spain.

At the cut-offs of ≥10kPa and ≥15kPa, the percentages were 2.5% and 0.8%, respectively, she stated in a presentation at the European Association for the Study of the Liver (EASL) annual meeting in Amsterdam.

Regarding specific metabolic risk factors, 10% of people with obesity (BMI ≥30) and 14.4% of those with type 2 diabetes (T2D) had LSM ≥8 kPa. In addition, 8.1% of individuals with current high-risk alcohol use (≥14 standard drink units weekly for women and 21 for men) had LSM ≥8 kPa. The prevalence of LSM ≥8 kPa increased with the number of risk factors, and hazardous alcohol consumption increased these percentages even more:

• One 2.2%; 7%
• Two: 5%; 9.7%
• Three: 9.6%; 15.5%
• Four: 20.5%; 36.1%

“In this large-scale European cohort, we found a high prevalence of undiagnosed liver fibrosis mainly related to steatotic liver disease driven by metabolic risk factors and/or high-risk alcohol consumption,” Graupera said. “Efforts should be made to identify liver fibrosis early to apply specific therapies that could reverse liver fibrosis.”

“Most patients with chronic liver disease [CLD] are diagnosed in advanced stage when they have already presented complications of cirrhosis or hepatocellular carcinoma,” explained Graupera. “Early detection — before cirrhosis develops — is critical, as fibrosis and liver damage is reversible with timely personalized intervention.”

However, she pointed out that studies indicate that undiagnosed liver fibrosis is quite common, but that these have mainly been small, single-country studies.

“Therefore, we aimed to investigate the prevalence of undiagnosed liver fibrosis using VCTE in a prospective…multi-national…cohort, and determine the association between liver fibrosis and metabolic risk factors and alcohol consumption,” she said.

LIVERSCREEN included 30,541 persons from Spain, Denmark, Italy, Slovakia, Croatia, U.K., France, Netherlands, and Germany. Most participants were women (57%) and white (89%), with a mean age of 58. Overweight was present in 40% and obesity was seen in 26%, while 35% had arterial hypertension, 10% had T2D, and 53% dyslipidemia.

Regarding alcohol use, 40% were never or former drinkers, while the remaining were current consumers of alcohol, including 7% who were high-risk alcohol consumers.

Among all participants, 8% were referred for further evaluation based on meeting at least one criteria for referral, including LSM ≥8 kPa, and increasing values of alanine transaminase (ALT) and gamma-glutamyl transferase.

The diagnostic criteria to establish the presence of significant CLD was a liver biopsy indicating fibrosis stage ≥F1. If no biopsy was conducted, a person had to have radiological signs of CLD on abdominal ultrasound and/or LSM ≥10 kPa.

The authors reported that 32% of those referred for evaluation were diagnosed with CLD with liver fibrosis, representing 1.5% of the overall study population.

Tw0-thirds of the individuals diagnosed with CLD had both increased liver stiffness and ALT levels — percentages that fell to 39% when individuals only had increased liver stiffness, and 13% when they only had increased ALT levels.

The main cause of CLD was steatotic liver disease, including metabolic dysfunction-associated steatotic liver disease (71%), metabolic dysfunction-associated alcohol-associated liver disease (14%), and alcohol-associated liver disease (5%).

In a 2024 press release, LIVERSCREEN project coordinator Pere Ginès, MD, PhD, also of Universidad de Barcelona, stated that “our development and validation of the LiverRisk score represent a major breakthrough, offering both diagnostic accuracy and prognostic value in predicting long-term liver-related outcomes.” Ultimately, the goal is to implement liver screening and the LiverRisk score into clinical settings, according to the release.