The following is a summary of the “Enhanced diagnosis of advanced fibrosis and cirrhosis in individuals with NAFLD using FibroScan-based Agile scores,” published in the February 2023 issue of Hepatology by Sanyal et al.

Modern non-invasive testing for NAFLD has a modest capacity to rule in advanced fibrosis (AF) (F 3) or cirrhosis but a high ability to rule out. These tests include the fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM by VCTE). This study aimed to create and validate 2 new scores (Agile 4 and Agile 3+) to detect cirrhosis and AF, respectively, in patients with NAFLD who visited liver clinics, with improved positive predictive value and fewer inconclusive outcomes.

Participants in this multinational study were drawn from seven adult cohorts with suspected NAFLD who had a liver biopsy, LSM, and blood samples as part of standard clinical practice or trial screening. Performance and goodness of fit were evaluated by randomly splitting the population into a training set and an internal validation set, on which the optimal logistic regression model was constructed. Also, two large cohorts were used for external validation of both scores. In the training set, we identified high sensitivity and specificity cutoffs for ruling in and out cirrhosis and AF, respectively; these were then validated in the validation set and compared to FIB-4 and LSM.

For Agile 3+, each score factored in LSM, AST/ALT ratio, platelets, sex, diabetic status, and age. The goodness of fit in calibration plots for Agile 4 and Agile 3+ was exceptional. Positive predictive value to rule out cirrhosis or AF was higher for Agile 4 and Agile 3+ compared to FIB-4 and LSM, and the percentage of patients with undetermined results was lower for Agile 4 and Agile 3+. Individuals with NAFLD who visit liver clinics can now be better identified as having cirrhosis or AF without having to undergo a liver biopsy, according to the two novel non-invasive scores.

Source: sciencedirect.com/science/article/pii/S0168827822032937