(Vienna, 25 June 2026) An international research team led by the Medical University of Vienna has investigated how to better assess the risk of severe complications in advanced steatotic liver disease—previously often referred to as fatty liver disease. The study shows that the most critical factor is the extent to which pressure in the liver’s blood circulation has already increased. When the severity of the disease is taken into account, the risk of complications is comparable across alcohol-related, metabolic, and mixed forms of steatotic liver disease. The findings were recently published in the journal Clinical Gastroenterology and Hepatology.
Steatotic liver diseases are common and can have various causes. They may be primarily associated with obesity, diabetes, or other metabolic disorders, can becaused by alcohol or result from a combination of several factors. In advanced stages of the disease, the liver can become increasingly scarred. As the disease progresses, serious complications such as ascites, bleeding from esophageal varices, or liver failure may occur.
So-called portal hypertension plays a central role in this process. This refers to elevated pressure in the venous system that transports blood to the liver. If this pressure is significantly elevated, the risk of complications increases. This pressure can be measured directly using a specialized test called the hepatic-venous pressure gradient. This method is highly informative but is not available everywhere. Therefore, tests that do not require direct intervention—such as measurements of liver stiffness and blood tests—are important.
Simpler assessment of actual risk
For the study, data from 696 patients at 17 European centers were analyzed. All had advanced but still stable (=compensated) chronic liver disease. The researchers compared three groups: patients with alcohol-related liver disease, those with metabolic liver disease, and those with a mixed form.
At first glance, complications occurred more frequently in patients with alcohol-related liver disease. However, a more detailed analysis revealed that this was primarily because these patients were already in a more advanced stage of the disease at the outset. When disease stage and portal hypertension were taken into account, the three groups no longer differed significantly in terms of risk of complications.
“Our results show that portal hypertension is a key prognostic factor across the entire spectrum of advanced steatotic liver diseases,” says Benedikt Hofer, the study’s first author. “This is clinically relevant because it allows us to better classify patients according to their actual risk.”
Non-invasive tests help in everyday clinical practice
The study also confirms that non-invasive tests are useful for risk assessment. In particular, a model combining liver stiffness, platelet count, and body mass index was able to accurately indicate the presence of clinically relevant portal hypertension across the various forms of the disease. Such methods can help physicians identify patients at increased risk earlier and provide them with more targeted care.
“Non-invasive tests do not replace specialized examinations in every situation, but they can significantly simplify risk assessment,” says Georg Semmler (Department of Medicine III, Division of Gastroenterology and Hepatology at MedUni Vienna), one of the study’s principal investigators. “Especially with a common condition like steatotic liver disease, it is important to identify early on those patients who are at increased risk for complications.”
The findings can help provide better guidance to patients with advanced liver disease in everyday clinical practice. What matters here is not only the cause of the disease, but above all how far it has already progressed and whether there is significant portal hypertension.
Publication: Clinical Gastroenterology and Hepatology
Hepatic venous pressure gradient, non-invasive tests, and prognosis across the subtypes of advanced steatotic liver disease.
Benedikt S. Hofer, Sarah Shalaby, Wilhelmus Kwanten et al.;
Baveno Cooperation: an EASL consortium.
DOI: 10.1016/j.cgh.2026.05.033