TY - JOUR
T1 - Increased accuracy in identifying NAFLD with advanced fibrosis and cirrhosis
T2 - independent validation of the Agile 3+ and 4 scores
AU - Noureddin, Mazen
AU - Mena, Edward
AU - Vuppalanchi, Raj
AU - Samala, Niharika
AU - Wong, Micaela
AU - Pacheco, Fabiana
AU - Polanco, Prido
AU - Sakkal, Celine
AU - Antaramian, Ani
AU - Chang, Devon
AU - Noureddin, Nabil
AU - Kohli, Anita
AU - Harrison, Stephen A.
AU - Gawrieh, Samer
AU - Alkhouri, Naim
AU - Truong, Emily
N1 - Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.
PY - 2023/5
Y1 - 2023/5
N2 - 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.
AB - 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.
KW - Humans
KW - Middle Aged
KW - Non-alcoholic Fatty Liver Disease/diagnosis
KW - Diabetes Mellitus, Type 2/complications
KW - ROC Curve
KW - Liver Cirrhosis/diagnostic imaging
KW - Fibrosis
UR - http://www.scopus.com/inward/record.url?scp=85183537235&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85183537235&partnerID=8YFLogxK
U2 - 10.1097/HC9.0000000000000055
DO - 10.1097/HC9.0000000000000055
M3 - Article
C2 - 37141504
SN - 2471-254X
VL - 7
JO - Hepatology Communications
JF - Hepatology Communications
IS - 5
M1 - e0055
ER -