Adaptation of Liver Stiffness Cutoff Values to Inflammation, Cholestasis, and Congestion

  • Sebastian MuellerEmail author


Liver stiffness (LS) is not only associated with fibrosis stage or matrix/collagen deposition but also many other clinical, cellular, and biophysical confounders. Most important clinical conditions that elevate LS include inflammation/hepatitis, congestion/elevated central venous pressure and mechanic cholestasis. Interestingly, steatosis is either not or even slightly negatively associated with LS, a fact that is still poorly understood. At the hemodynamic levels, LS elevation can be interpreted by the inflow/outflow balance model where both an increase of blood inflow either through portal vein or hepatic artery and an impaired outflow through hepatic veins or bile duct will increase LS. In clinical practice, these confounders often present in combination. Confounders of LS elevation are not only important for correct clinical interpretation of elevated LS, but also have a negative prognostic impact on fibrosis progression per se (see also sinusoidal pressure hypothesis). This chapter provides algorithms and practical hints to correctly interpret an elevated LS within the clinical context. An on-time abdominal ultrasound and actual laboratory parameters (namely AST levels) are most useful for a correct interpretation of LS.


Fibrosis Cholestasis Steatosis Congestion Inflammation Noninvasive tests Transient elastography Biomarker 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Medicine and Center for Alcohol Research and Liver DiseasesSalem Medical Center, University of HeidelbergHeidelbergGermany

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