Liver stiffness as a dynamic predictor of decompensation and mortality in alcohol-related liver disease

Alcohol-related liver disease (ALD) is a significant global health concern, contributing substantially to liver-related morbidity and mortality. Liver stiffness measurement (LSM) has emerged as a non-invasive, reliable method for assessing liver fibrosis and cirrhosis in ALD. This review examines the role of LSM in predicting and monitoring the risk of decompensation and mortality in ALD patients. We conducted a comprehensive analysis of recent literature on LSM techniques, including transient elastography, magnetic resonance elastography, acoustic radiation force impulse imaging, and shear wave elastography. The review focused on the pathophysiology of liver stiffness in ALD, the predictive value of LSM for hepatic decompensation and mortality, and its use in monitoring disease progression and treatment response. LSM demonstrates strong predictive power for hepatic decompensation and mortality in ALD, with values above 20–25 kPa generally associated with increased risk. Serial LSM measurements provide valuable insights into disease progression and the effects of alcohol abstinence or relapse. Integration of LSM with other biomarkers and prognostic models enhances risk stratification and clinical decision-making. However, challenges remain in standardizing LSM techniques and establishing ALD-specific cutoff values. LSM represents a significant advance in ALD management, offering a dynamic and repeatable measure of liver health. Its ability to predict clinical outcomes and monitor treatment response makes it a valuable tool in guiding clinical care. Future research should focus on standardization, multimodal approaches combining LSM with other biomarkers, and the application of artificial intelligence to LSM data analysis to further improve its clinical utility in ALD management.