A RECENT study presented at ECR 2025 has identified the Functional Liver Imaging Score (FLIS) as a valuable prognostic biomarker for predicting acute-on-chronic liver failure (ACLF) in patients with advanced chronic liver disease (ACLD). The findings, derived from gadoxetic acid-enhanced MRI, could enhance risk stratification and clinical management for at-risk patients.
The study included 322 ACLD patients who underwent GA-MRI-derived, semi-quantitative FLIS assessment, along with other imaging parameters such as relative liver enhancement (RLE), relative enhancement ratio of the biliary system (REB), and liver-to-portal vein contrast ratio (LPC). Two independent radiologists computed these parameters, and patients were categorised as either stable ACLD or acutely decompensated (AD), based on their hospitalisation status.
Key findings indicated that FLIS was significantly lower in AD patients compared to those with stable ACLD. More importantly, a low FLIS was identified as an independent risk factor for ACLF development and liver-related death. Specifically, in AD patients, a reduced FLIS was associated with more than twice the risk of ACLF or liver-related mortality (adjusted hazard ratio [aHR]: 2.26; 95% confidence interval [CI]: 1.08-4.71; P=0.03). Similarly, among stable ACLD patients, a low FLIS increased the risk of adverse outcomes (aHR: 2.35; 95% CI: 1.21-4.55; P=0.01).
While other quantitative imaging markers, including RLE, REB, and LPC, were effective in distinguishing between stable and AD patients (P<0.001), they did not independently predict ACLF development or liver-related mortality. This reinforces the potential of FLIS as a superior imaging biomarker for clinical risk assessment.
The study highlights FLIS as a simple yet effective tool for identifying ACLD patients at heightened risk of ACLF, enabling timely intervention, intensified monitoring, or early liver transplant evaluation. However, researchers acknowledge the retrospective design as a limitation, noting the potential for selection bias. Nevertheless, the study benefits from a long clinical follow-up and a robust number of endpoints.
These findings offer a promising step forward in hepatology, providing clinicians with a non-invasive, imaging-based approach to improve patient outcomes in ACLD management.
Reference
Kristic A et al. Functional Liver Imaging Score: a biomarker for prediction of acute-on-chronic liver failure. RPS 401. ECR Annual Meeting, 26 February-02 March, 2025.
