AGILE 3+ Score for the Diagnosis of Advanced Fibrosis and for Predicting Liver-related Events in NAFLD

Pennisi, Grazia; Enea, Marco; Pandolfo, Alessandra; Celsa, Ciro; Antonucci, Michela; Ciccioli, Carlo; Infantino, Giuseppe; Mantia, Claudia La; Parisi, Stefanie; Tulone, Adele; Marco, V. Di; Craxı̀, Antonio; Cammà, Calogero; Petta, Salvatore

doi:10.1016/j.cgh.2022.06.013

Cited by 43 publications

(59 citation statements)

References 29 publications

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“…2) and comparable with previous studies. 15,21 The diagnostic performance of Agile scores was significantly greater than those for the FIB-4 index and the ELF score (Figure 3). Moreover, the proportion of patients with indeterminate values was successfully reduced by Agile 3+ and Agile 4 compared with LSM solo examination.…”

Section: Proportion Of Patients With Indeterminate Value Of Agile 3+ ...mentioning

confidence: 95%

Validation of the utility of Agile scores to identify advanced fibrosis and cirrhosis in Japanese patients with nonalcoholic fatty liver disease

Oeda

Seko

Hayashi

et al. 2023

Hepatology Research

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Aim Agile 3+ and Agile 4 scores, based on liver stiffness measurement (LSM) by transient elastography and clinical parameters, were recently reported to be effective in identifying advanced fibrosis and cirrhosis in nonalcoholic fatty liver disease (NAFLD). This study aimed to validate the utility of these scores in Japanese patients with NAFLD. Methods Six hundred forty‐one patients with biopsy‐proven NAFLD were analyzed. The severity of liver fibrosis was pathologically evaluated by one expert pathologist. The LSM, age, sex, diabetes status, platelet count, and aspartate aminotransferase and alanine aminotransferase levels were used to calculate Agile 3+ scores, and the parameters above excluding age were used for Agile 4 scores. The diagnostic performance of the two scores was evaluated using receiver operating characteristic (ROC) curve analysis. Sensitivity, specificity, and predictive values of the original low cut‐off (for rule‐out) value and high cut‐off (for rule‐in) value were tested. Results For diagnosis of fibrosis stage ≥3, the area under the ROC (AUROC) was 0.886, and the sensitivity of the low cut‐off value and the specificity of the high cut‐off value were 95.3% and 73.4%, respectively. For diagnosis of fibrosis stage 4, AUROC, the sensitivity of the low cut‐off value, and the specificity of the high cut‐off value were 0.930, 100%, and 86.5%, respectively. Both scores had higher diagnostic performance than the FIB‐4 index and the enhanced liver fibrosis score. Conclusions Agile 3+ and Agile 4 are reliable noninvasive tests to identify advanced fibrosis and cirrhosis in Japanese NAFLD patients with adequate diagnostic performance.

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Section: Proportion Of Patients With Indeterminate Value Of Agile 3+ ...mentioning

confidence: 95%

Validation of the utility of Agile scores to identify advanced fibrosis and cirrhosis in Japanese patients with nonalcoholic fatty liver disease

Oeda

Seko

Hayashi

et al. 2023

Hepatology Research

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“…The ALT, AST and platelet count were measured for all participants. The FIB‐4 index, 48 FAST score, 43 Agile 3+ 44 and Agile 4 45 scores were calculated using published formulae based on age, sex, CAP, LSM, AST, ALT, platelet count and presence of diabetes, as appropriate. Published cutoffs for TE‐based scoring systems were applied to rule‐out and rule‐in fibrosis, as follows: 0.35 and 0.67, respectively, for FAST (fibrosis stage ≥2); 0.45 and 0.68, for Agile 3+ (fibrosis stage 3–4); 0.25 and 0.57, respectively, for Agile 4 (fibrosis stage 4, or cirrhosis) 49–51 .…”

Section: Methodsmentioning

confidence: 99%

“…Among them, FibroScan-AST (FAST) was devised to identify patients with non-alcoholic steatohepatitis showing elevated NAFLD activity score (NAS; ≥4) and fibrosis stage ≥2 (significant fibrosis), 43 whereas Agile 3+ and Agile 4 were developed to detect fibrosis stages 3-4 (advanced fibrosis) and fibrosis stage 4 (cirrhosis), respectively. 44,45 In this context, there is increasing evidence suggesting that NITs for fibrosis could be used as important predictors of long-term clinical outcomes. 39,41,42,46,47 The question as to whether laboratory-and/or imaging-based NIT scores reflecting severity of hepatic fibrosis could be associated with the burden of NAFLD from the patient's perspective is not fully investigated.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, several scoring systems based on the combination of TE with other clinical and/or laboratory parameters have been proposed to improve diagnostic accuracy for fibrosis staging. Among them, FibroScan‐AST (FAST) was devised to identify patients with non‐alcoholic steatohepatitis showing elevated NAFLD activity score (NAS; ≥4) and fibrosis stage ≥2 (significant fibrosis), 43 whereas Agile 3+ and Agile 4 were developed to detect fibrosis stages 3–4 (advanced fibrosis) and fibrosis stage 4 (cirrhosis), respectively 44,45 . In this context, there is increasing evidence suggesting that NITs for fibrosis could be used as important predictors of long‐term clinical outcomes 39,41,42,46,47 …”

Section: Introductionmentioning

confidence: 99%

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Impairment of patient‐reported outcomes among patients with non‐alcoholic fatty liver disease: a registry‐based study

Yılmaz

Toraman

Alp

et al. 2022

Aliment Pharmacol Ther

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Background: Patients with non-alcoholic fatty liver disease (NAFLD) and more advanced fibrosis tend to have more impairment in their health-related quality of life and other patient-reported outcomes (PROs). Aim: To assess the association of PROs with select non-invasive tests (NITs) for fibrosis including FAST, Agile 3+ and Agile 4 scores Methods: We enrolled patients with an established diagnosis of NAFLD who were seen in a tertiary care clinic into the NAFLD/NASH Registry. The FAST, Agile 3+ and Agile 4 scores were calculated using liver stiffness measurements by transient elastography and laboratory parameters. PROs were assessed using FACIT-F, CLDQ-NASH and WPAI instruments (total of 17 domain and summary scores).Results: There were 1509 patients with NAFLD (mean age: 49 ± 11 years, 50% men, 41% employed, 30% advanced fibrosis and 20% cirrhosis). The mean FAST, Agile 3+ and Agile 4 scores were 0.39 ± 0.26, 0.35 ± 0.31 and 0.12 ± 0.23, respectively. Subjects with lower FAST, Agile 3+ and Agile 4 scores had the highest scores in select domains of FACIT-F, CLDQ-NASH and WPAI (p < 0.05 in comparison to subjects with elevated or high-risk NIT scores). Correlations with continuous NITs were significantly negative for Emotional and Functional well-being (FACIT-F), Activity/energy, Systemic symptoms, Worry and total scores (CLDQ-NASH), and Activity of WPAI (p < 0.05); the strongest was for Worry (CLDQ-NASH) with FAST (R = −0.17, p < 0.0001). The PRO scores of patients with NAFLD were lower than those of matched patients with chronic hepatitis B (p < 0.05 for 9/17 domain and summary scores). Conclusion:Patients with NAFLD and high FAST, Agile 3+ or Agile 4 scores experience impairment of health-related quality of life.

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“…To this end liver ultrasound elastography methods are reliable and convenient methods [10], as also shown by Bauer in this issue of the journal [6] and thus recommended. Furthermore, liver stiffness values contribute to build accurate prognostication score for liver disease evolution [11]. However, Petta and colleagues have demonstrated that higher degrees of liver fat infiltration increase the risk of overestimation of liver fibrosis assessed by ultrasound elastography [12] and that the combination of liver fat quantification with elastography makes the non-invasive liver staging in NAFLD patients more accurate [13].…”

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confidence: 99%

Liver Fat Quantification: When do We Need It?

Piscaglia¹,

Stefanini²,

Terzi³

et al. 2023

Ultraschall Med

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AGILE 3+ Score for the Diagnosis of Advanced Fibrosis and for Predicting Liver-related Events in NAFLD

Cited by 43 publications

References 29 publications

Validation of the utility of Agile scores to identify advanced fibrosis and cirrhosis in Japanese patients with nonalcoholic fatty liver disease

Validation of the utility of Agile scores to identify advanced fibrosis and cirrhosis in Japanese patients with nonalcoholic fatty liver disease

Impairment of patient‐reported outcomes among patients with non‐alcoholic fatty liver disease: a registry‐based study

Liver Fat Quantification: When do We Need It?

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