Published online May 22, 2022. doi: 10.4291/wjgp.v13.i3.96
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
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).
To clarify the significance of VCTE-based scoring systems to narrow the high-risk group of NAFLD patients with comorbidities.
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.
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.
Agile 3+ and Agile 4 are useful to narrow the NAFLD patient group, in which patients may have HCC and/or EGV.
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.