Europe scanned 30,000 livers and found undiagnosed liver disease in 1.6%

Liver fibrosis is a disease of the asymptomatic. By the time it announces itself, it is usually cirrhosis. That is the argument for screening the general population, and it has been made for years on the strength of small single-country studies. LiverScreen, published in The Lancet this month, is the first attempt to test it at continental scale [s1].

The project enrolled 30,199 people aged 40 and over from the general population across nine European countries, recruiting through 35 sites including primary health centres and screening units, each linked to one of 16 affiliated tertiary hospitals [s1]. Mean age was 58, and 57% of participants — 17,203 of 30,199 — were women [s1]. The cohort was 89% White, 24,440 of the 27,481 for whom ethnicity was recorded [s1].

Each participant had a liver stiffness measurement taken by vibration-controlled transient elastography, the ultrasound-based technique commonly known by the trade name FibroScan [s1]. A screen was counted as positive if liver stiffness reached 8 kPa or higher, or if alanine aminotransferase was at least 1.5 times the upper limit of normal, or both [s1].

Two numbers, and why they differ

The screening result and the diagnostic result are not the same number, and LiverScreen is unusually clear about the distance between them.

The positive screening rate was 6.9%, and the prevalence of a liver stiffness measurement of 8 kPa or greater was 4.6% [s1]. Everyone with at least one positive criterion was referred for a hepatology consultation. Of those referred, 61% — 1,491 of 2,457 — actually completed the evaluation [s1]. Among that group, chronic liver disease with fibrosis was confirmed in 32%, or 477 of 1,491 [s1].

Applied to the full enrolled cohort, that gives an overall estimated prevalence of confirmed, previously undiagnosed chronic liver disease with fibrosis of 1.6% — 477 people out of 30,199 [s1].

The drop from 6.9% screening positive to 1.6% confirmed is the practical story here. Two-thirds of people who screened positive and completed a specialist evaluation did not have confirmed chronic liver disease with fibrosis [s1]. Transient elastography readings are elevated by things other than fibrosis — recent food intake, congestion, inflammation, obesity itself can degrade measurement reliability. Any national programme built on this approach would be running a large false-positive queue through hepatology clinics.

The shortfall between the 2,457 people referred and the 1,491 who were evaluated is its own finding [s1]. A large minority of people told their liver screen was abnormal did not reach a specialist. Whatever the mix of reasons — access, anxiety, indifference, logistics — it is a realistic estimate of what leakage looks like in a research setting with dedicated staff, which means real-world programmes would likely do worse.

What was driving it

Metabolic risk was near-universal in the cohort: 70% of participants, 21,084 of 30,024, had metabolic factors present [s1]. Alcohol use was reported by 59% — 15,107 of 25,488 — and 6.1%, or 1,771 of 29,081, reported harmful consumption [s1].

Elevated liver stiffness was strongly associated with obesity, type 2 diabetes and harmful alcohol use [s1]. And of the 477 confirmed cases, 443 — 93% — were steatotic liver disease [s1].

That last figure is the one that should shape how the result is read. This is not a study about hepatitis or rare liver disease. It is a study about the liver consequences of metabolic dysfunction and alcohol in middle-aged Europeans, and it finds them common, invisible and clustered in people whose risk factors are already documented in their medical records.

The limits

LiverScreen is a prevalence study, not a trial. It shows that undiagnosed fibrosis can be found; it does not show that finding it improves outcomes. Nobody was randomised to screening versus no screening, and there is no follow-up here on whether the 477 people identified went on to do better than they would have otherwise. That is the question a screening programme has to answer, and it remains open.

The cohort's composition also constrains generalisation. At 89% White and drawn from nine European countries, it does not describe populations where viral hepatitis carries more of the fibrosis burden [s1]. And an entry age of 40 means nothing here speaks to younger adults, in whom metabolic liver disease is rising.

The study was funded by the European Commission, the Fondo de Investigación Sanitaria de Salud, the Spanish Ministry of Economy, Industry and Competitiveness, and the European Regional Development Fund [s1].

What to watch

The authors' framing is that early detection is pivotal because it could allow personalised interventions that prevent progression to cirrhosis and its complications [s1]. "Could" is doing real work in that sentence, and the paper does not pretend otherwise.

The decision facing European health systems is narrower than universal screening. Given that elevated stiffness clustered in obesity, type 2 diabetes and harmful alcohol use — three groups already known to primary care — the live question is whether targeted case-finding in those groups is worth funding, and what the confirmatory pathway looks like when two-thirds of positives turn out not to have the disease.

Sources

• [s1] Prevalence of liver fibrosis in the general population (the LiverScreen project): a multinational European cohort study — The Lancet, published online 10 April 2026. https://doi.org/10.1016/S0140-6736(26)00354-5