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

Author:

Noureddin Mazen1ORCID,Mena Edward2,Vuppalanchi Raj3ORCID,Samala Niharika3ORCID,Wong Micaela2,Pacheco Fabiana2,Polanco Prido4,Sakkal Celine4,Antaramian Ani56,Chang Devon7,Noureddin Nabil8ORCID,Kohli Anita4,Harrison Stephen A.9ORCID,Gawrieh Samer3,Alkhouri Naim4ORCID,Truong Emily106

Affiliation:

1. Houston Methodist Hospital, Houston Research Institute, Houston, Texas, USA

2. California Liver Institute, Pasadena, California, USA

3. Indiana University, Indianapolis, Indiana, USA

4. Arizona Liver Health, Phoenix, Arizona, USA

5. Comprehensive Transplant Center, Los Angeles, California, USA

6. Cedars-Sinai Medical Center, Los Angeles, California, USA

7. Arnold O. Beckman High School, Irvine, California, USA

8. Division of Gastroenterology, University of California at San Diego, La Jolla, California, USA

9. Radcliffe Department of Medicine, University of Oxford, England, UK

10. Department of Medicine Center, Los Angeles, California, USA

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Hepatology

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