Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities

Miura, Kouichi; Maeda, Hiroshi; Morimoto, Naoki; Watanabe, Shunji; Tsukui, Mamiko; Takaoka, Yuri; Nomoto, Hiroaki; Goka, Rie; Kotani, Kazuhiko; Yamamoto, Hironori

doi:10.4291/wjgp.v13.i3.96

Cited by 6 publications

(10 citation statements)

References 20 publications

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“…Miura et al. identified the utility of Agile scores to capture the risk of HCC and esophagogastric varices of Japanese NAFLD patients in a cross‐sectional study 26 . These findings suggest that Agile scores could be a marker for prediction of longitudinal clinical outcome, as well as a marker for liver fibrosis.…”

Section: Discussionmentioning

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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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: Discussionmentioning

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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“…14 Although Agile scores do not include information on body mass index or single nucleotide polymorphisms, we found that the predictive performance of Agile scores for LREs was similar to that in European patients. 9 This study also overcame two weaknesses of the previous study 12 : (1) excellent predictive performance for LREs, without adjustment for systemic factors, including age and diabetes. We also found a low PPV of Agile scores for liver fibrosis had little effect on the prediction of LREs.…”

Section: Discussionmentioning

confidence: 85%

“…We found that Agile 3+ and Agile 4 are good tools for identification of NAFLD patients with HCC and/or EGVs 12 . However, this former study was a cross‐sectional study using patients with ultrasonography‐diagnosed NAFLD.…”

Section: Introductionmentioning

confidence: 76%

“…We found that Agile 3+ and Agile 4 are good tools for identification of NAFLD patients with HCC and/or EGVs. 12 However, this former study was a cross-sectional study using patients with ultrasonography-diagnosed NAFLD. The predictive performance of Agile scores used for LREs has not been fully investigated in patients with biopsy-proven NAFLD.…”

Section: Introductionmentioning

confidence: 97%

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

Miura,

Hayashi,

Kamada

et al. 2023

Hepatology Research

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AimThe 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.

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“…[123] The score was later shown to be associated with HCC risk in patients cured of HCV, but not in patients with NAFLD. [124,125] Similarly, the MRE-FIB-4 index was developed to estimate fibrosis severity in patients with NAFLD, and later was found to be associated with adverse outcomes, including HCC development. [40] Pathogen-related HCC risk biomarkers Microbiome in the digestive tract and changes in its composition, namely dysbiosis, are associated with exacerbating or protective effects on liver disease severity and HCC risk via cellular signaling such as tolllike receptor pathway, metabolites, bile acids, fatty acids, lipopolysaccharide, and other biomolecules.…”

Section: Imaging-based Hcc Risk Scores/ Biomarkersmentioning

confidence: 99%

Risk stratification and early detection biomarkers for precision HCC screening

et al. 2022

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Hepatocellular carcinoma (HCC) mortality remains high primarily due to late diagnosis as a consequence of failed early detection. Professional societies recommend semi-annual HCC screening in at-risk patients with chronic liver disease to increase the likelihood of curative treatment receipt and improve survival. However, recent dynamic shift of HCC etiologies from viral to metabolic liver diseases has significantly increased the potential target population for the screening, whereas annual incidence rate has become substantially lower. Thus, with the contemporary HCC etiologies, the traditional screening approach might not be practical and cost-effective. HCC screening consists of (i) definition of rational at-risk population, and subsequent (ii) repeated application of early detection tests to the population at regular intervals. The suboptimal performance of the currently available HCC screening tests highlights an urgent need for new modalities and strategies to improve early HCC detection. In this review, we overview recent developments of clinical, molecular, and imaging-based tools to address the current challenge, and discuss conceptual framework and approaches of their clinical translation and implementation. These encouraging progresses are expected to transform the current "one-size-fits-all" HCC screening into

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Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities

Cited by 6 publications

References 20 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

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

Risk stratification and early detection biomarkers for precision HCC screening

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