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Background <p>In December 2023, a multisociety Delphi consensus redefined the nomenclature of steatotic liver disease (SLD). This study aims to evaluate the impact of the revised criteria on chronic liver disease etiology classification.</p> Methods <p>We retrospectively analyzed adult patients with non-viral SLD who underwent Vibration-controlled Transient Elastography at a single medical center between November 2017 and February 2024. Clinical data were reviewed for metabolic risk factors and alcohol intake, and patients were reclassified based on the 2023 criteria.</p> Results <p>Of 478 patients, 262 met inclusion criteria (mean age 62.5 years; 87.8% male); 98.9% had at least one cardiometabolic risk factor. Reclassification altered the assigned SLD etiology in 17.5% of cases. Among 12 previously cryptogenic cases, 9 were reclassified as MASLD and 3 as MetALD. MetALD accounted for 12.6% of the cohort, primarily reclassified from prior ALD or NAFLD diagnosis. Patients with ALD had significantly higher mean Liver Stiffness Measurement values (18.82&#xa0;kPa) than MASLD (mean difference = 7.86&#xa0;kPa, 95% CI [2.39, 13.34], <i>p</i> = 0.003). Patients with MASLD had significantly higher mean Controlled Attenuation Parameter (309.57 dB/m) compared to those with ALD (mean difference = 33.28 dB/m, 95% CI [15.56, 51.00], <i>p</i> &lt; 0.001). Alcohol use documentation was lacking in 6.1% of cases. Most ALD and MetALD patients had no pharmacologic treatment for alcohol use disorder, and referral to substance use treatment programs occurred in just over half (56.2%).</p> Conclusion <p>The revised SLD framework reclassified nearly 1 in 5 patients, uncovering unrecognized metabolic or alcohol-related liver disease. ALD was associated with greater liver stiffness, suggesting higher kPa cut-offs may be warranted for fibrosis staging.</p>

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Impact of Revised Steatotic Liver Disease Criteria on Chronic Liver Disease Etiology in Veterans – A Retrospective Study

  • 期刊论文

  • 发表日期：

    2026年3月26日

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  • Thanita Thongtan,
  • Navila Sharif,
  • Anand Shah,
  • Thuy-Van Hang

摘要

Background

In December 2023, a multisociety Delphi consensus redefined the nomenclature of steatotic liver disease (SLD). This study aims to evaluate the impact of the revised criteria on chronic liver disease etiology classification.

Methods

We retrospectively analyzed adult patients with non-viral SLD who underwent Vibration-controlled Transient Elastography at a single medical center between November 2017 and February 2024. Clinical data were reviewed for metabolic risk factors and alcohol intake, and patients were reclassified based on the 2023 criteria.

Results

Of 478 patients, 262 met inclusion criteria (mean age 62.5 years; 87.8% male); 98.9% had at least one cardiometabolic risk factor. Reclassification altered the assigned SLD etiology in 17.5% of cases. Among 12 previously cryptogenic cases, 9 were reclassified as MASLD and 3 as MetALD. MetALD accounted for 12.6% of the cohort, primarily reclassified from prior ALD or NAFLD diagnosis. Patients with ALD had significantly higher mean Liver Stiffness Measurement values (18.82 kPa) than MASLD (mean difference = 7.86 kPa, 95% CI [2.39, 13.34], p = 0.003). Patients with MASLD had significantly higher mean Controlled Attenuation Parameter (309.57 dB/m) compared to those with ALD (mean difference = 33.28 dB/m, 95% CI [15.56, 51.00], p < 0.001). Alcohol use documentation was lacking in 6.1% of cases. Most ALD and MetALD patients had no pharmacologic treatment for alcohol use disorder, and referral to substance use treatment programs occurred in just over half (56.2%).

Conclusion

The revised SLD framework reclassified nearly 1 in 5 patients, uncovering unrecognized metabolic or alcohol-related liver disease. ALD was associated with greater liver stiffness, suggesting higher kPa cut-offs may be warranted for fibrosis staging.