Enhanced diagnosis of advanced fibrosis and cirrhosis in individuals with NAFLD using FibroScan-based Agile scores

Sanyal, Arun J.; Foucquier, Julie; Younossi, Zobair M.; Harrison, Stephen A.; Newsome, Philip N.; Chan, Wah‐Kheong; Yılmaz, Yusuf; Lédinghen, Victor de; Costentin, Charlotte; Zheng, Ming‐Hua; Wong, Vincent Wai‐Sun; Elkhashab, Magdy; Huss, Ryan; Myers, Robert P.; Roux, Marine; Labourdette, Aymeric; Destro, Marie; Fournier-Poizat, Céline; Miette, Véronique; Sandrin, Laurent; Boursier, Jérôme

doi:10.1016/j.jhep.2022.10.034

Cited by 81 publications

(116 citation statements)

References 27 publications

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“…Patients with an unreliable LSM were excluded from this study. The cut-off values used in the study by Sanyal et al 15 were also used in the present study to test the diagnostic performance of LSMs for comparison with Agile scores, and the prevalence of the indeterminate zone was obtained. A low cut-off value of 9.2 kPa was used to rule out stage ≥3 and a high cut-off value of 13.6 kPa was used to rule in stage ≥3.…”

Section: Liver Stiffness Measurementmentioning

confidence: 99%

“…Agile 3+ and Agile 4 are combination algorithms based on transient elastography to predict patients with stage ≥3 fibrosis and stage 4 fibrosis in NAFLD. 15 Agile 3+ is calculated using the LSM obtained with the FibroScan (Echosens; Paris, France), serum AST level, serum ALT level, PLT, sex, age, and the presence/absence of diabetes. Agile 4 is calculated using the parameters above excluding age (Figure S1).…”

Section: Introductionmentioning

confidence: 99%

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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: Liver Stiffness Measurementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“… 77 The Fibroscan-based Agile scores, that is, Agile 3+ and Agile 4, combine liver stiffness measurement and routinely available clinical parameters to improve the diagnosis of advanced fibrosis and cirrhosis, respectively, and performed better than liver stiffness measurement alone and FIB-4 alone. 78 As mentioned earlier, the FibroTouch is another vibration controlled transient elastography device, and it can be similarly used for liver stiffness measurement. The optimal cut-off for the diagnosis of advanced fibrosis has been found to be 9.4 kPa.…”

Section: Non-invasive Assessment Of Hepatic Fibrosismentioning

confidence: 99%

Non-invasive assessment of metabolic dysfunction–associated fatty liver disease

Kumar

Skantha

Chan

2022

Therapeutic Advances in Endocrinology

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Non-alcoholic fatty liver disease (NAFLD) affects an estimated one-quarter of the global adult population and has become one of the leading causes of end-stage liver disease and hepatocellular carcinoma with increased liver-related and overall morbidity and mortality. The new term, metabolic dysfunction–associated fatty liver disease (MAFLD), has a set of positive diagnostic criteria and has been shown to have better clinical utility, but it has yet to be universally adopted. This review addresses the non-invasive tests for MAFLD and is based mostly on studies on NAFLD patients, as the MAFLD term is relatively new and there are limited studies on non-invasive tests based on this new term, while a large body of research work on non-invasive tests has accumulated in the literature for NAFLD. This review focuses on blood-based biomarkers and scores for the assessment of hepatic steatosis, non-alcoholic steatohepatitis (NASH), and fibrosis, and two of the most widely studied imaging biomarkers, namely vibration-controlled transient elastography and magnetic resonance imaging. Fibrotic NASH has become a diagnostic target of interest and novel serum biomarkers and scores incorporating imaging biomarker for diagnosis of fibrotic NASH are emerging. Nonetheless, the degree of liver fibrosis remains the key predictor of liver-related morbidity and mortality in patients with MAFLD. A multitude of non-invasive biomarkers and scores have been studied for the detection of liver fibrosis, including use of sequential non-invasive tests for risk stratification of advanced liver fibrosis. In addition, this review will explore the utility of the non-invasive tests for prognostication and for monitoring of treatment response.

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“…Agile 3+ and Agile 4 are models that combine LSM with routine clinical parameters to identify advanced fibrosis and cirrhosis, respectively. Both Agile 4 and Agile 3+ showed better diagnostic performance, especially positive predictive value, than FIB-4 and LSM [ 96 ]. Acoustic radiation force imaging (ARFI) was developed from a chronic hepatitis C patient cohort to diagnose advanced fibrosis.…”

Section: Noninvasive Markers Are More Practical Than Liver Biopsy For...mentioning

confidence: 99%

Surveillance of the progression and assessment of treatment endpoints for nonalcoholic steatohepatitis

Shi¹,

Fan²

2023

Clin Mol Hepatol

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Nonalcoholic steatohepatitis (NASH) is the aggressive form of nonalcoholic fatty liver disease (NAFLD), characterized as steatosis-associated inflammation and liver injury.Without effective treatment or management, NASH would develop life-threatening outcomes. In this situation, evaluation and identification of those at-risk for adverse outcomes are important. The key issues in screening NASH patients are the assessment of advanced fibrosis, differentiation of NASH from simple steatosis, and their dynamic changes during follow-up. Currently, the staging for NASH and evaluation of effectiveness for drugs still rely on pathological diagnosis, while liver biopsy brings sample error issues and subjectivity. To address this problem, optimizing the pathological assessment and developing noninvasive surrogate methods for accessible, accurate, and safe evaluation is of significance. Although noninvasive methods including elastography, serum soluble biomarkers and combined models have been widely studied in the last decade, the application of noninvasive diagnostic measurements in clinical practice is still insufficient. Much work remains to be done in establishing cost-effective strategies both for screening for at-risk NASH and identify the changes of disease severity. In this review, we summarized the current state of the noninvasive methods for detecting steatosis, steatohepatitis and fibrosis of NASH, introduced the noninvasive assessment for screening at-risk patients, and focused on the characteristics should be monitored in the follow-up.

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Enhanced diagnosis of advanced fibrosis and cirrhosis in individuals with NAFLD using FibroScan-based Agile scores

Cited by 81 publications

References 27 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

Non-invasive assessment of metabolic dysfunction–associated fatty liver disease

Surveillance of the progression and assessment of treatment endpoints for nonalcoholic steatohepatitis

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