Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Screening for fibrosis to diagnose liver diseases early: the LIVERSCREEN project

Nature Medicine volume 29, pages 774–775 (2023)Cite this article

Subjects

Chronic liver diseases are common and represent a leading cause of death worldwide and a significant economic burden for healthcare systems1,2. Several etiological factors can cause chronic liver disease, the most frequent being excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis B and C virus infections. Although the prevalence of hepatitis B and C virus infections is decreasing in many areas of the world owing to vaccination and effective antiviral drugs, the rates of alcohol-related liver diseases and NAFLD are growing as a result of increasing alcohol consumption as well as obesity and diabetes in the population2,3,4. Any of these etiological factors, acting either alone or in combination (for example, obesity plus excessive alcohol consumption), may cause continuous liver inflammation and hepatocyte necrosis, resulting in liver fibrosis due to collagen deposition within the liver parenchyma5. Progressive disruption of liver architecture by scarring fibrosis together with hepatocyte necrosis leads to the development of cirrhosis with portal hypertension and liver failure. Cirrhosis results in life-threatening complications, which are responsible for multiple hospital admissions, impaired quality of life and high mortality6. Moreover, a substantial proportion of patients with cirrhosis may develop hepatocellular carcinoma. Notably, the entire process, from the start of subclinical liver inflammation to the occurrence of complications, progresses very slowly, usually over more than 20 years, and is asymptomatic. For this reason, in most cases a diagnosis is not made until cirrhosis is advanced and patients are symptomatic from complications of portal hypertension and/or liver cancer7. At these late stages, cirrhosis is irreversible and has a high mortality, with survival dependent on liver transplantation, which unfortunately is only available and feasible in a minority of patients. Therefore, there is an urgent need to change the current paradigm for diagnosing chronic liver diseases away from diagnosis after patients have advanced cirrhosis with complications and toward the early diagnosis of asymptomatic, reversible liver fibrosis before cirrhosis develops, as emphasized recently by the European Association for the Study of the Liver (EASL)-Lancet Liver Commission7. Such a change of paradigm could allow the application of personalized therapeutic intervention(s) to stop disease progression, thereby reducing morbidity, mortality and healthcare burden from these diseases.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. GBD 2010 Diseases and Injuries Collaborators. Lancet 396, 1204–1222 (2020).

    Article  Google Scholar 

  2. Asrani, S. K. et al. J. Hepatol. 70, 151–171 (2019).

    Article  PubMed  Google Scholar 

  3. Zhang, X. et al. BMC Gastroenterol. 22, 484 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Riazi, K. et al. Lancet Gastroenterol. Hepatol. 7, 851–861 (2022).

    Article  PubMed  Google Scholar 

  5. Pellicoro, A. et al. Nat. Rev. Immunol. 14, 181–194 (2014).

    Article  CAS  PubMed  Google Scholar 

  6. Ginès, P. et al. Lancet 398, 1359–1376 (2021).

    Article  PubMed  Google Scholar 

  7. Karlsen, T. D. et al. Lancet 399, 61–116 (2022).

    Article  PubMed  Google Scholar 

  8. European Association for the Study of the Liver. J. Hepatol. 75, 659–689 (2021).

    Article  Google Scholar 

  9. Graupera, I. et al. BMC Public Health 22, 1385 (2022).

Download references

Acknowledgements

The LiverScreen project is funded by European Union’s Horizon2020 programme under grant agreement no. 847989.

Author information

Authors and Affiliations

  1. Liver Unit Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Pere Ginès & Isabel Graupera

  2. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Pere Ginès, Isabel Graupera, Núria Fabrellas & Anita Arslanow

  3. Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain

    Pere Ginès, Isabel Graupera & Núria Fabrellas

  4. Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Pere Ginès, Isabel Graupera & Núria Fabrellas

  5. Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark

    Maja Thiele & Aleksander Krag

  6. Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark

    Maja Thiele & Aleksander Krag

  7. Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland

    Miquel Serra-Burriel

  8. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands

    Robert J. de Knegt

  9. Department of Medicine II, Saarland University Medical Center, Homburg, Germany

    Frank Lammert

  10. Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany

    Frank Lammert

  11. Hannover Medical School (MHH), Hannover, Germany

    Frank Lammert

  12. Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France

    Laurent Castera

  13. European Liver Patients Association (ELPA), Brussels, Belgium

    Marko Korenjak

  14. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA

    Patrick S. Kamath

  15. Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia

    Ivica Grgurević

  16. Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia

    Ivica Grgurević

  17. Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy

    Salvatore Piano

Authors
  1. Pere Ginès
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maja Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabel Graupera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miquel Serra-Burriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert J. de Knegt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Lammert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laurent Castera
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marko Korenjak
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Patrick S. Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ivica Grgurević
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Salvatore Piano
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Núria Fabrellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Anita Arslanow
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Aleksander Krag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pere Ginès.

Ethics declarations

Competing interests

P.G. has received research funding from Gilead, Mallinckrodt, Grifols and Ferring; consulting fees from Grifols SA, Ferring Pharmaceuticals, Gilead, Intercept, Martin Pharmaceuticals, Promethera, Sequana, RallyBio and Behring. M.T. has been funded by a grant from the Novo Nordisk Foundation (DECIDE project, grant no. NNF20OC0059393), and received speaker’s fee from Echesens, Siemens Healthcare, Norgine and Tillotts Pharma and an advisory fee from GE Healthcare. R.J.dK. has received honoraria for consulting or speaking in the past 5 years from AbbVie, BMS, Echosens, Gilead, Jansen-Cilag and Norgine; fees for contract research for current trials from Echosens, GSK, Inventiva-Pharma and Jansen-Cilag; and research grants from Gilead. L.C. has received a research grant from Gilead; consulting fees from Echosens, Madrigal, MSD, Novo Nordisk, Pfizer and Sagimet; and lecture fees from Echosens and Novo Nordisk. I. Grgurević has received speaker fees from Echosens, Siemens and Roche and holds an advisory board position at General Electric. S.P. has received consulting fees from Plasma Protein Therapeutics Association and Resolution therapeutics. N.F. has received consulting fees from Intercept. All other authors report no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ginès, P., Thiele, M., Graupera, I. et al. Screening for fibrosis to diagnose liver diseases early: the LIVERSCREEN project. Nat Med 29, 774–775 (2023). https://doi.org/10.1038/s41591-023-02265-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41591-023-02265-z

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing