Novel dynamic and static biomarkers for the assessment of liver disease severity in MASLD

In the field of metabolic-dysfunction associated steatotic liver disease (MASLD), the use of non-invasive tests for the identification of liver fibrosis and disease severity represents one of the most rapidly evolving landscapes. Liver fibrosis is recognized as the most relevant prognostic factor, but liver biopsy is still required for its diagnosis and staging. With the increasing prevalence of MASLD and its progressive, chronic inflammatory form, Metabolic-dysfunction associated steatohepatitis (MASH), the use of non-invasive tests become critical for risk stratification in the primary care as well as hepatological setting. Non-invasive tests may include blood-based scores or direct fibrogenesis biomarkers (so called wet biomarkers), which display dynamic changes over time and may be useful for longitudinal purposes, including prognostication and response to treatment (lifestyle interventions as well as response to pharmacological treatments). Imaging-based techniques (so called dry biomarkers), including vibration-controlled transient elastography, magnetic resonance elastography or spleen stiffness measurement, can detect the severity of liver disease and may be appropriate (as “static” tools) for risk stratification and identification of best candidates for specific treatments or personalized management and follow-up. In this review, we will summarize the updated evidence on the use of most validated tools and biomarkers for liver fibrosis in MASLD, according to the setting and their role in the patient management.