Increased accuracy in identifying NAFLD with advanced fibrosis and cirrhosis: independent validation of the Agile 3+ and 4 scores

Mazen Noureddin, Edward Mena, Raj Vuppalanchi, Niharika Samala, Micaela Wong, Fabiana Pacheco, Prido Polanco, Celine Sakkal, Ani Antaramian, Devon Chang, Nabil Noureddin, Anita Kohli, Stephen A. Harrison, Samer Gawrieh, Naim Alkhouri, Emily Truong

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background and Aims: We explored 2 novel scores, Agile 3+ and 4, to identify advanced fibrosis (≥ F3) and cirrhosis (F4), respectively, in NAFLD and compared their diagnostic performances to liver stiffness measurement (LSM) by vibration-controlled transient elastography and fibrosis-4 index (FIB-4) (for Agile 3+). Approach and Results: This multicenter study included 548 NAFLD patients with laboratory testing, liver biopsy, and vibration-controlled transient elastography within 6 months. Agile 3+ and 4 were applied and compared with FIB-4 or LSM alone. Goodness of fit was evaluated using a calibration plot and discrimination using area under the receiver operating curve. Area under the receiver operating curves was compared using the Delong test. Dual cutoff approaches were applied to rule out and rule in ≥ F3 and F4. Median (interquartile range) age was 58 (15) years. Median body mass index was 33.3 (8.5) kg/m2. Fifty-three percent had type 2 diabetes, 20% had F3, and 26% had F4. Agile 3+ demonstrated an area under the receiver operating curve of 0.85 (0.81; 0.88) similar to that of LSM [0.83 (0.79; 0.86), p = 0.142] but significantly higher than that of FIB-4 [0.77 (0.73; 0.81), p < 0.0001). Agile 4's area under the receiver operating curve [0.85 (0.81; 0.88)] was similar to that of LSM [0.85 (0.81; 0.88), p = 0.065). However, the percentage of patients with indeterminate results was significantly lower with Agile scores compared with FIB-4 and LSM (Agile 3+: 14% vs. FIB-4: 31% vs. LSM: 13%, p < 0.001; Agile 4: 23% vs. LSM: 38%, p < 0.001). Conclusions: Agile 3+ and 4 are novel vibration-controlled transient elastography-based noninvasive scores that increase accuracy in the identification of advanced fibrosis and cirrhosis respectively and are ideal for clinical use due to a lower percentage of indeterminant outputs compared with FIB-4 or LSM alone.

Original languageEnglish (US)
Article numbere0055
JournalHepatology Communications
Volume7
Issue number5
DOIs
StatePublished - May 2023

Keywords

  • Humans
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease/diagnosis
  • Diabetes Mellitus, Type 2/complications
  • ROC Curve
  • Liver Cirrhosis/diagnostic imaging
  • Fibrosis

ASJC Scopus subject areas

  • Hepatology

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