Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease

Nicola Pugliese; Trenton M.  White; Paul N Brennan; Silvana  Pannain; Hannes Hagström; Maurice Michel; Lisa Rice-Duek; Giovanni  Targher; Cyrielle Caussy; John F Dillon; Frank Tacke; Christopher J.  Kopka; Giada Sebastiani; Jerome Boursier; Emmanuel A. Tsochatzis; Willem Pieter Brouwer; Giovanni Guaraldi; Roberto Vettor; Maja Thiele; Michael Roden; Norbert Stefan; Helen Jarvis; Pere Ginès; Jörn M Schattenberg; Elisa  Pose; Stefan Buttigieg; Christopher D Byrne; Jeffrey V. Lazarus

doi:10.1016/j.lanepe.2026.101722

Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease

Nicola Pugliese
, Trenton M. White
, Paul N Brennan
, Silvana Pannain
, Hannes Hagström
, Maurice Michel
, Lisa Rice-Duek
, Giovanni Targher
, Cyrielle Caussy
, John F Dillon
, Frank Tacke
, Christopher J. Kopka
, Giada Sebastiani
, Jerome Boursier
, Emmanuel A. Tsochatzis
, Willem Pieter Brouwer
, Giovanni Guaraldi
, Roberto Vettor
, Maja Thiele
, Michael Roden

Norbert Stefan, Helen Jarvis, Pere Ginès, Jörn M Schattenberg, Elisa Pose, Stefan Buttigieg, Christopher D Byrne, Jeffrey V. Lazarus (Lead / Corresponding author)

Respiratory Medicine and Gastroenterology

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Abstract

Steatotic liver disease (SLD) is the leading cause of chronic liver disease in Europe, with liver fibrosis representing the strongest predictor of liver-related outcomes and an important contributor to cardiometabolic risk. This Series paper examines diagnostic innovation and models of care to improve fibrosis detection and risk stratification across the continuum of care for SLD. A growing range of non-invasive tests for fibrosis assessment is now available, including blood-based biomarkers, imaging modalities, automated laboratory algorithms, and artificial intelligence-enabled tools. However, implementation remains inconsistent because of limited awareness, restricted geographic and financial access to advanced diagnostics, fragmented referral pathways, heterogeneous reimbursement, limited use of automated reflex testing, and poor digital integration across laboratories and electronic health records. Integrated multidisciplinary models of care linking primary care with specialist services may improve early fibrosis detection, referral efficiency, and equitable access to risk-stratified management, particularly among people living with indicator conditions such as type 2 diabetes and obesity.

Original language	English
Article number	101722
Number of pages	13
Journal	The Lancet Regional Health - Europe
Volume	65
DOIs	https://doi.org/10.1016/j.lanepe.2026.101722
Publication status	Published - 2 Jun 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

MASLD
metALD
non-invasive tests
diagnostic innovation
fibrosis detection
risk stratification
models of care
blood-based biomarkers
diagnostic pathways
precision hepatology

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10.1016/j.lanepe.2026.101722Licence: CC BY-NC-ND

Final Published VersionFinal published version, 1.99 MBLicence: CC BY-NC-ND

Assessing Europe's policy readiness to confront the MASLD/MASH public health threat
Lazarus, J. V. (Lead / Corresponding author), White, T. M. (Lead / Corresponding author), Agirre-Garrido, L., Abeysekera, K. W. M., Brennan, P. N., Brůha, R., Buttigieg, S., Carrieri, P., Cortez-Pinto, H., Flisiak, R., Francque, S. M. A., Frühbeck, G., Gheorghe, L. S., Hagström, H., Holleboom, A. G., Ivanov, K., Jensterle, M., Jepsen, P., Kupcinskas, J. & Mark, H. E. & 18 others, Mauricio, D., Bibi, S. M., Moreno, C., Mrzljak, A., Papanicolaou, E., Papp, M., Papatheodoridis, G., Peck-Radosavljevic, M., Pugliese, N., Johnson, R. D., Ribeiro, R. T., Salupere, R., Skladany, L., Tolmane, I., Yki-Järvinen, H., Schattenberg, J. M., Pericàs, J. M. & The European MASLD collaborator group, 2 Jun 2026, In: The Lancet Regional Health - Europe. 65, 17 p., 101713.
Research output: Contribution to journal › Article › peer-review

Open Access
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Implementation of evidence-based alcohol policies to reduce alcohol-related harm and liver disease to advance public health in Europe
Pose, E. (Lead / Corresponding author), Díaz, L. A., Parker, R., Israelsen, M., Marjot, T., Forrest, E., Dhanda, A., Paradis, C., Arab, J. P., Krag, A., Bataller, R., Murray, F., Lazarus, J. V., Carrieri, P. & Brennan, P. N., 2 Jun 2026, In: The Lancet Regional Health - Europe. 65, 101707.
Research output: Contribution to journal › Article › peer-review

Open Access
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3 Downloads (Pure)

Cite this

Pugliese, N., White, T. M., Brennan, P. N., Pannain, S., Hagström, H., Michel, M., Rice-Duek, L., Targher, G., Caussy, C., Dillon, J. F., Tacke, F., Kopka, C. J., Sebastiani, G., Boursier, J., Tsochatzis, E. A., Brouwer, W. P., Guaraldi, G., Vettor, R., Thiele, M., ... Lazarus, J. V. (2026). Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease. The Lancet Regional Health - Europe, 65, Article 101722. https://doi.org/10.1016/j.lanepe.2026.101722

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title = "Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease",

abstract = "Steatotic liver disease (SLD) is the leading cause of chronic liver disease in Europe, with liver fibrosis representing the strongest predictor of liver-related outcomes and an important contributor to cardiometabolic risk. This Series paper examines diagnostic innovation and models of care to improve fibrosis detection and risk stratification across the continuum of care for SLD. A growing range of non-invasive tests for fibrosis assessment is now available, including blood-based biomarkers, imaging modalities, automated laboratory algorithms, and artificial intelligence-enabled tools. However, implementation remains inconsistent because of limited awareness, restricted geographic and financial access to advanced diagnostics, fragmented referral pathways, heterogeneous reimbursement, limited use of automated reflex testing, and poor digital integration across laboratories and electronic health records. Integrated multidisciplinary models of care linking primary care with specialist services may improve early fibrosis detection, referral efficiency, and equitable access to risk-stratified management, particularly among people living with indicator conditions such as type 2 diabetes and obesity.",

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Pugliese, N, White, TM, Brennan, PN, Pannain, S, Hagström, H, Michel, M, Rice-Duek, L, Targher, G, Caussy, C, Dillon, JF, Tacke, F, Kopka, CJ, Sebastiani, G, Boursier, J, Tsochatzis, EA, Brouwer, WP, Guaraldi, G, Vettor, R, Thiele, M, Roden, M, Stefan, N, Jarvis, H, Ginès, P, Schattenberg, JM, Pose, E, Buttigieg, S, Byrne, CD & Lazarus, JV 2026, 'Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease', The Lancet Regional Health - Europe, vol. 65, 101722. https://doi.org/10.1016/j.lanepe.2026.101722

TY - JOUR

T1 - Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease

AU - Pugliese, Nicola

AU - White, Trenton M.

AU - Brennan, Paul N

AU - Pannain, Silvana

AU - Hagström, Hannes

AU - Michel, Maurice

AU - Rice-Duek, Lisa

AU - Targher, Giovanni

AU - Caussy, Cyrielle

AU - Dillon, John F

AU - Tacke, Frank

AU - Kopka, Christopher J.

AU - Sebastiani, Giada

AU - Boursier, Jerome

AU - Tsochatzis, Emmanuel A.

AU - Brouwer, Willem Pieter

AU - Guaraldi, Giovanni

AU - Vettor, Roberto

AU - Thiele, Maja

AU - Roden, Michael

AU - Stefan, Norbert

AU - Jarvis, Helen

AU - Ginès, Pere

AU - Schattenberg, Jörn M

AU - Pose, Elisa

AU - Buttigieg, Stefan

AU - Byrne, Christopher D

AU - Lazarus, Jeffrey V.

PY - 2026/6/2

Y1 - 2026/6/2

N2 - Steatotic liver disease (SLD) is the leading cause of chronic liver disease in Europe, with liver fibrosis representing the strongest predictor of liver-related outcomes and an important contributor to cardiometabolic risk. This Series paper examines diagnostic innovation and models of care to improve fibrosis detection and risk stratification across the continuum of care for SLD. A growing range of non-invasive tests for fibrosis assessment is now available, including blood-based biomarkers, imaging modalities, automated laboratory algorithms, and artificial intelligence-enabled tools. However, implementation remains inconsistent because of limited awareness, restricted geographic and financial access to advanced diagnostics, fragmented referral pathways, heterogeneous reimbursement, limited use of automated reflex testing, and poor digital integration across laboratories and electronic health records. Integrated multidisciplinary models of care linking primary care with specialist services may improve early fibrosis detection, referral efficiency, and equitable access to risk-stratified management, particularly among people living with indicator conditions such as type 2 diabetes and obesity.

AB - Steatotic liver disease (SLD) is the leading cause of chronic liver disease in Europe, with liver fibrosis representing the strongest predictor of liver-related outcomes and an important contributor to cardiometabolic risk. This Series paper examines diagnostic innovation and models of care to improve fibrosis detection and risk stratification across the continuum of care for SLD. A growing range of non-invasive tests for fibrosis assessment is now available, including blood-based biomarkers, imaging modalities, automated laboratory algorithms, and artificial intelligence-enabled tools. However, implementation remains inconsistent because of limited awareness, restricted geographic and financial access to advanced diagnostics, fragmented referral pathways, heterogeneous reimbursement, limited use of automated reflex testing, and poor digital integration across laboratories and electronic health records. Integrated multidisciplinary models of care linking primary care with specialist services may improve early fibrosis detection, referral efficiency, and equitable access to risk-stratified management, particularly among people living with indicator conditions such as type 2 diabetes and obesity.

KW - MASLD

KW - metALD

KW - non-invasive tests

KW - diagnostic innovation

KW - fibrosis detection

KW - risk stratification

KW - models of care

KW - blood-based biomarkers

KW - diagnostic pathways

KW - precision hepatology

U2 - 10.1016/j.lanepe.2026.101722

DO - 10.1016/j.lanepe.2026.101722

M3 - Article

SN - 2666-7762

VL - 65

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 101722

ER -

Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease

Abstract

UN SDGs

Keywords

Access to Document

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Research output

Assessing Europe's policy readiness to confront the MASLD/MASH public health threat

Implementation of evidence-based alcohol policies to reduce alcohol-related harm and liver disease to advance public health in Europe

Cite this