Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. May 22, 2022; 13(3): 96-106
Published online May 22, 2022. doi: 10.4291/wjgp.v13.i3.96
Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities
Kouichi Miura, Hiroshi Maeda, Naoki Morimoto, Shunji Watanabe, Mamiko Tsukui, Yoshinari Takaoka, Hiroaki Nomoto, Rie Goka, Kazuhiko Kotani, Hironori Yamamoto
Kouichi Miura, Hiroshi Maeda, Naoki Morimoto, Shunji Watanabe, Mamiko Tsukui, Yoshinari Takaoka, Hiroaki Nomoto, Rie Goka, Hironori Yamamoto, Department of Medicine, Division of Gastroenterology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 329-0498, Tochigi, Japan
Kazuhiko Kotani, Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan
Author contributions: Miura K designed the study and performed acquisition, analysis, interpretation of data, and drafted the initial manuscript; Maeda H participated in acquisition and analysis of data; Morimoto N participated in acquisition of data; Watanabe S participated in acquisition of data; Tsukui M participated in acquisition of data; Takaoka Y participated in acquisition of data; Nomoto H participated in acquisition of data; Goka R participated in acquisition of data; Kotani K, a specialist of biostatistics, reviewed the statistical analysis and revised the draft carefully; Yamamoto H revised the draft carefully.
Institutional review board statement: The present study was reviewed and approved by the Institutional Review Board of Jichi Medical University (20-175).
Informed consent statement: A written informed consent was waived because of the retrospective nature of this study. Instead, opt-out consent documents were shown on the website of Jichi Medical University for patients who did not wish to participate in the study.
Conflict-of-interest statement: There are no conflict of interest to report.
Data sharing statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy policies.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kouichi Miura, Doctor, Associate Professor, Department of Medicine, Division of Gastroenterology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 329-0498, Tochigi, Japan. miura385@jichi.ac.jp
Received: January 8, 2022
Peer-review started: January 8, 2022
First decision: March 9, 2022
Revised: March 21, 2022
Accepted: May 14, 2022
Article in press: May 14, 2022
Published online: May 22, 2022
Abstract
BACKGROUND

Vibration-controlled transient elastography (VCTE) is proposed as a second step of examination to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) after triaging by the fibrosis-4 (FIB-4) index. Recently, VCTE-based scoring systems, including FibroScan-AST (FAST), Agile 3+, and Agile 4, emerged to determine the status of NAFLD. However, the significance of these scoring systems remains unknown in narrowing the high-risk group of NAFLD patients with comorbidities, including hepatocellular carcinoma (HCC) and esophagogastric varices (EGV).

AIM

To clarify the significance of VCTE-based scoring systems to narrow the high-risk group of NAFLD patients with comorbidities.

METHODS

We performed a cross-sectional study to investigate the usefulness of VCTE-based scoring systems and other fibrosis markers to narrow the high-risk group of patients with NAFLD. FIB-4 index was used for the first triage. Risk groups of FAST, Agile 3+, and Agile 4 were stratified according to the published data. Among the 191 patients with NAFLD, there were 26 (14%) and 25 patients (13%) with HCC and EGV, respectively.

RESULTS

When 1.3 was used as a cutoff value, the FIB-4 index narrowed the risk group to 120 patients, in which all patients with HCC and/or EGV were included. High risk group of Agile 3+ could subsequently narrow the risk group. The prevalence of HCC and EGV at this step were 33% (26/80) and 31% (25/80), respectively. In further narrowing of EGV, Agile 4 aggregated the patients with EGV into 43 patients, of whom 23 (53%) had EGV. FAST failed to narrow the risk group of patients with comorbidities. When 2.6 was used as a cutoff value of the FIB-4 index, three patients with HCC and two patients with EGV were missed at the first triage.

CONCLUSION

Agile 3+ and Agile 4 are useful to narrow the NAFLD patient group, in which patients may have HCC and/or EGV.

Keywords: Nonalcoholic fatty liver disease, Vibration controlled transient elastography, Non-invasive test, Hepatocellular carcinoma, Varix

Core Tip: It is necessary to narrow the high-risk group of nonalcoholic fatty liver disease (NAFLD) patients with comorbidities, including hepatocellular carcinoma (HCC) and esophagogastric varices (EGV). Although the fibrosis-4 index is an excellent formula to narrow the high-risk group, there remain many patients to be ruled out. Vibration controlled transient elastography (VCTE) is proposed as a second step examination. FibroScan-AST, Agile 3+, and Agile 4 emerged as VCTE-based scoring systems to determine the status of patients with NAFLD. Here, we demonstrated that Agile 3+ and Agile 4 are good tools to narrow the high-risk group of patients with HCC and/or EGV.