Agile 3+ and Agile 4, noninvasive tests for liver fibrosis, are excellent formulae to predict liver‐related events in nonalcoholic fatty liver disease

Abstract

AbstractAimThe noninvasive tests (NITs) Agile 3+ and Agile 4 effectively identify patients with nonalcoholic fatty liver disease (NAFLD) complicated with advanced fibrosis (F3–4) and cirrhosis (F4), respectively. Little information is available on associations between Agile scores and intra‐/extrahepatic events. The aim of this study was to determine the predictive performance of Agile scores for intra‐/extrahepatic events in Asian patients with biopsy‐proven NAFLD.MethodsWe undertook a retrospective multicenter cohort study to investigate associations between intra‐/extrahepatic events and two Agile scores, Agile 3+ and Agile 4. The scores were obtained by combining clinical parameters and liver stiffness measurement using transient elastography.ResultsAmong 403 enrolled patients, 11 had liver‐related events (LREs), including seven with hepatocellular carcinoma (HCC). The incidence of LREs and HCC showed a stepwise increase in the advanced fibrosis group (F3–4), Agile 3+ rule‐in (F3–4, highly suspected), and Agile 4 rule‐in (F4, highly suspected) groups, compared to their counterparts. Hazard ratios for LREs in the advanced fibrosis group, Agile 3+ rule‐in, and Agile 4 rule‐in groups were 4.05 (p = 0.03), 23.5 (p = 0.003), and 45.5 (p < 0.001), respectively. The predictive performance results for Agile 3+ and Agile 4 were 0.780 and 0.866, respectively, which were higher than for fibrosis (0.595). Unlike for LREs, Agile scores failed to identify patients with extrahepatic events, including cardiovascular events and extrahepatic cancer.ConclusionsAgile 3+ and Agile 4 scores are excellent NITs for predicting LREs in patients with NAFLD, possibly without histological assessment.