{
  "abstract": "BACKGROUND/AIMS: Liver stiffness measurement (LSM) is a key tool for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD), yet static thresholds fail to capture dynamic transition across risk strata. We aimed to characterize LSM-risk transitions and develop a time-updated, individualized model for predicting state transitions, liver-related events and death (LREs/death). METHODS: In a real-world MASLD cohort, we applied a multi-state, time-homogeneous Markov model to quantify annual transition probabilities and mean state occupancy times across LSM-defined low-, intermediate-, and high-risk strata. A Markov model incorporating age, sex, type 2 diabetes (T2D), hypertension was used to generate individualized, time-updated risk trajectories and probabilities of LREs/death. RESULTS: Among 11,514 MASLD individuals with ≥2 vibration-controlled transient elastography assessments, the low-risk category demonstrated notable stability, with 92% remaining unchanged at 1 year and a mean occupancy time of 8.43 years (95% confidence interval [CI] 7.94-8.95). Contrarily, the intermediate-risk category was highly dynamic, with only 39% remaining unchanged after 1 year and a mean occupancy time of 0.92 years (95% CI 0.88-0.96). T2D, hypertension, and obesity substantially shorten low-risk occupancy time, whereas antidiabetic medication was associated with more favorable transitions. Finally, we developed a dynamic, multi-state Markov model integrating longitudinal LSM-defined risk states with relevant covariates to generate individualized predictions of state transitions and risks of LREs/death. CONCLUSIONS: LSM-based strata in MASLD represent distinct and meaningful dynamic trajectories. In particular, the marked instability of the intermediate-risk state supports more frequent reassessment. By quantifying transition pathways and time-updated risks of LREs/death, this model may inform the personalized surveillance intervals and risk-adapted management.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 23,
  "authors": [
    {
      "name": "Yu Shi"
    },
    {
      "name": "Ruoqi Zhou"
    },
    {
      "name": "Seung Up Kim"
    },
    {
      "name": "Terry Cheuk-Fung Yip"
    },
    {
      "name": "Salvatore Petta"
    },
    {
      "name": "Elisabetta Bugianesi"
    },
    {
      "name": "Masato Yoneda"
    },
    {
      "name": "Manuel Romero-Gomez"
    },
    {
      "name": "Emmanuel Tsochatzis"
    },
    {
      "name": "Philip Newsome"
    },
    {
      "name": "Hannes Hagström"
    },
    {
      "name": "George Boon-Bee Goh"
    },
    {
      "name": "Wah-Kheong Chan"
    },
    {
      "name": "José-Luis Calleja"
    },
    {
      "name": "Jerome Boursier"
    },
    {
      "name": "Arun Sanyal"
    },
    {
      "name": "Jian-Gao Fan"
    },
    {
      "name": "Laurent Castera"
    },
    {
      "name": "Victor De Lédinghen"
    },
    {
      "name": "Michelle Lai"
    },
    {
      "name": "Xiao-Dong Zhou"
    },
    {
      "name": "Vincent Wai-Sun Wong"
    },
    {
      "name": "Ming-Hua Zheng"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/11xa5wztfmwbw.bib",
  "cited_by": 0,
  "doi": "10.3350/cmh.2026.0279",
  "fulltext_url": null,
  "id": "11xa5wztfmwbw",
  "issns": [
    "2287-2728",
    "2287-285X"
  ],
  "landing_url": "https://hal.science/hal-05841019v1",
  "language": "en",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "openalex",
      "2713|Liver Disease Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7161807885",
  "pdf_url": "https://www.e-cmh.org/upload/pdf/cmh-2026-0279.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-01",
  "publisher": "Korean Association for the Study of the Liver",
  "ris": "https://research.draconitic.com/paper/11xa5wztfmwbw.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "hal-05841019",
      "source": "hal",
      "url": "https://hal.science/hal-05841019v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Liver Disease Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "The natural history and individualized prediction of liver stiffness-based fibrosis risk in metabolic dysfunction-associated steatotic liver disease",
  "title_text": "The natural history and individualized prediction of liver stiffness-based fibrosis risk in metabolic dysfunction-associated steatotic liver disease",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/11xa5wztfmwbw",
  "venue": "Clinical and molecular hepatology",
  "versions": []
}