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.

Background and aims: Nonselective beta blockers (NSBB) are extensively used in patients with cirrhosis for prophylaxis of variceal bleeding and prevention of decompensation. In the setting of Acute kidney injury (AKI), guidelines recommend NSBB discontinuation. However, this recommendation is based on experts’ opinion, and to date,no studies have evaluated the effects of NSBB on AKI outcomes.Methods: Post hoc analysis of ICA GLOBAL-AKI study, a multicenter intercontinental study that prospectively enrolled patients hospitalized for acute decompensation (AD) of cirrhosis from July 2022 to May 2023. AKI outcomes were compared between patients on NSBB at AKI diagnosis and those who were not. A subgroup analysis further examined outcomes between patients in whom NSBB were continued during hospitalization and those in whom were tapered/withdrawn. Patients were propensity score-matched (PSM), in 1:1 ratio, by age, sex, MELD-Na, mean arterial pressure (MAP), presence of ascites, grade 3-4 hepatic encephalopathy, AKI stage and acute on chronic liver failure (ACLF) grade at AKI diagnosis. Main outcomes were AKI resolution and 28-day mortality. Results: Of 1238 patients with AKI and available data about NSBB treatment, 503 (41%) were on NSBB at AKI diagnosis. Patients on NSBB were older and had significantly lower heart rate, MAP, white blood cell (WBC) count than patients not on NSBB. They also had significantly lower MELD-Na score and significantly lower prevalence of grade 2 and 3 ACLF. After PSM, patients on NSSB showed significantly lower WBC count, while no differences were found between the two cohorts in AKI precipitant and phenotypes. Patients on NSBB experienced higher rates of complete AKI resolution (68% vs 58%, p = 0.001). NSBB treatment at AKI diagnosis was associated with higher likelihood of AKI resolution (OR=1.54 [95% CI=1.19–2.00], p=0.001) and reduced 28-day mortality (sHR=0.68 [95% CI=0.52–0.89], p=0.005). During the first 48 – 72 hours of hospitalization, NSBB were continued in 123 patients (24%) and discontinued/tapered in 350 (70%); data were not available for the remaining 30 patients. After PSM, no differences were found between the two groups in AKI precipitant and phenotypes, AKI peak stage, development of organ failures, intensive care unit and organ support requirement (vasopressor use, mechanical ventilation, renal replacement therapy). After PSM, continuation of NSBB was neither associated with AKI resolution (OR=1.00 [95% CI=0.56–1.79], p=0.999) nor with 28-day mortality (sHR=0.56 [95% CI=0.24–1.34], p=0.190). Conclusion: NSBB use at AKI diagnosis was associated with improved renal recovery and survival in patients with acutely decompensated cirrhosis and AKI. Continuation during hospitalization does not appear harmful, supporting careful individualized management rather than systematic withdrawal.