New study reveals promising South West-born innovation to find liver disease earlier

Highlights

• Case-finding platform hepatoSIGHT CLDI^™ shown effective at identifying people with liver fibrosis from the general population more accurately than standard first-line tools 
• Results from the LiveWell study announced today (27 May, 2026) at the EASL Congress
• hepatoSIGHT CLDI^™ is scaling from Somerset NHS Foundation Trust to thirteen further sites in the South West 
• Health Innovation South West Health welcomes the results, as we provide implementation and real-world evaluation support to Predictive Health Intelligence for hepatoSIGHT CLDI^™ deployment 

Predictive Health Intelligence today (27 May, 2026) announced results from the LiveWell study at the EASL Congress, demonstrating that hepatoSIGHT CLDI^™ is a highly effective method for identifying people with clinically significant liver fibrosis from the general population using routinely collected NHS laboratory data.

Today at EASL | The Home of Hepatology 2026, Dr Tim Jobson is presenting late-breaking data from the LiveWell study, showing that CLDI can identify clinically significant fibrosis from the general population more accurately than standard first-line tools.

The key finding: CLDI, using routine NHS laboratory data to assess the cumulative burden of liver injury over time, is significantly more effective than other standard fibrosis tools.

This matters for clinicians, researchers, and sponsors working to find the right patients earlier.

The study, sponsored by Sano Genetics and funded by Innovate UK, shows that the Cumulative Liver Damage Index (CLDI) can identify clinically significant fibrosis more accurately than commonly used first-line investigations. This will enable a major shift in how liver disease is identified and managed within NHS pathways.

Chronic liver disease represents a growing challenge for the NHS. Death rates have increased more than fourfold since the 1970s, in contrast to improvements seen in many other chronic conditions. Liver disease is typically progressive and asymptomatic until advanced stages, meaning patients are often identified too late for effective intervention. Despite this, there is no national screening programme, in part because existing approaches have not been sufficiently accurate or cost-effective at scale.

Once there is a suspicion of liver disease, the current NHS pathway typically relies on a two-step approach. A first-line score such as FIB-4 is used to identify patients at risk, followed by more expensive second-line testing with Enhanced Liver Fibrosis (ELF™) or transient elastography. While this is more efficient than unguided referral, the performance of first-line investigations in the general population is limited, impeding effort to improve earlier identification.

The LiveWell study evaluated an alternative approach using CLDI, a longitudinal measure derived from routine blood tests. This captures cumulative liver injury over time, using the hepatoSIGHT case-finding platform. Rather than relying on a single test result, CLDI reflects the total burden of liver damage built up over years.

In this study, CLDI demonstrated strong performance for identifying clinically significant fibrosis amongst the general population, achieving an AUC of 0.884. This compares favourably to published population-level performance for FIB-4 of 0.572.

“These findings are an exciting and important step forward, showing how patients can know more, sooner, and have a better chance to act before serious damage is done,” said Larry R. Holden, President and CEO of the Global Liver Institute. “For patients and families, earlier identification means more opportunity, more informed choices, and more hope. This is exactly the kind of progress we need if we are going to turn the tide on chronic liver disease.”

The study recruited 994 participants prospectively from a single NHS site in less than a year, providing a substantial real-world dataset and supporting the feasibility of this approach within routine clinical pathways.

Furthermore, by using CLDI to identify high-risk individuals directly from historic data, patients can be referred straight to transient elastography, effectively creating a one-step pathway from identification to diagnostic confirmation. This reduces unnecessary sequential testing and minimises burden on both patients and services. A CLDI based pathway would be simpler, and significantly cheaper than one based on sequential blood tests. During the LiveWell study, patients identified using CLDI were invited for a non-invasive liver scan through Tawazun Health’s rapid access FibroScan® pathway, alongside genetic profiling provided by Sano Genetics. This demonstrated a possible real-world delivery model, linking population-level risk stratification to timely non-invasive assessment.

“This study is a meaningful step forward for people living with undiagnosed liver disease. The fact that CLDI can identify clinically significant fibrosis this accurately, using data that already exists in NHS systems, changes what earlier identification can realistically look like at scale,” said Charlotte Guzzo, Chief Operating Officer of Sano Genetics. “We are proud to have supported this work and excited to see where the larger validation study takes it.”

The implications extend beyond clinical care. Patient identification remains a major constraint in liver disease research, particularly in metabolic dysfunction-associated steatotic liver disease (MASLD), where there are currently over 130 active studies ongoing. By enabling more accurate identification of patients at scale, CLDI has the potential to significantly accelerate recruitment, reduce screen failure rates, and improve trial efficiency.

“After more than 20 years as an NHS gastroenterologist, I have seen too many patients whose liver disease was only found once serious damage had already been done. Chronic liver disease develops silently over many years, so it makes sense that we should look at the pattern of liver injury over time, not just single blood tests in isolation. These findings show that using routine NHS data in this way could help us identify people at higher risk much earlier and create a simpler, more targeted pathway for assessment before advanced disease develops.”

hepatoSIGHT has received funding to extend its footprint across the South West of England, with further rollouts planned in 2027. A wider validation study of CLDI involving 8,000 patients is now in progress, with results expected later this summer. This will further assess the performance of CLDI across multiple sites.

Health Innovation South West have provided both implementation support and real-world evaluation support to Predictive Health Intelligence for a scaled deployment of hepatoSIGHT.

Predictive Health Intelligence received funding to scale hepatoSIGHT from a single trust, Somerset NHS Foundation Trust, to thirteen further sites in seven Integrated Care Boards across the South West region. This represents a large public health data-driven initiative in the UK. The aims are to enable earlier identification and management of patients with liver disease, embed new referral and surveillance pathways, and generate real-world evidence to inform the programme, its sustainability and wider adoption. 

Health Innovation South West is providing implementation support and real-world evaluation support to Predictive Health Intelligence for this scaled deployment of hepatoSIGHT. Learn more. 

This work was supported by Innovate UK Grant Number iUK 10073169.