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

• Published in: Hepatology communications 2023-05, Vol.7 (5)
• Main Authors: Noureddin, Mazen, Mena, Edward, Vuppalanchi, Raj, Samala, Niharika, Wong, Micaela, Pacheco, Fabiana, Polanco, Prido, Sakkal, Celine, Antaramian, Ani, Chang, Devon, Noureddin, Nabil, Kohli, Anita, Harrison, Stephen A, Gwarieh, Samer, Alkhouri, Naim, Truong, Emily
• Format: Article
• Language: English
• Subjects: Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Fibrosis; Humans; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Middle Aged; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Original; ROC Curve
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1097/HC9.0000000000000055

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+). 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