Agile 3+ and Agile 4 scores are accurate to detect advanced metabolic dysfunction-associated steatotic liver disease

BACKGROUND: The prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) is related to the presence of liver fibrosis (LF). The Agile 3+ and Agile 4 scores are proposed as noninvasive methods to identify advanced LF and cirrhosis, respectively, associating vibration-controlled transient elastography (VCTE) with clinical and laboratorial data. AIM: To evaluate the performance of Agile scores in the assessment of LF in MASLD patients. METHODS: This is a cross-sectional multicentric study conducted at three gastroenterology/hepatology outpatient units from Brazil, including individuals with biopsy-proven MASLD. To calculate the Agile 3+ and Agile 4 scores for the evaluation of advanced fibrosis (F≥3) and cirrhosis (F4), respectively, the formula proposed by Sanyal et al . was applied. RESULTS: A total of 220 patients were included, mostly women ( n = 146; 66%) and with diabetes ( n = 136; 61.5%). The prevalence of advanced fibrosis and cirrhosis was 21.82% ( n = 48) and 9.55% ( n = 21), respectively. There was a strong correlation between Agile 3+ ( r = 0.751) and VCTE ( r = 0.729) with the LF stage evaluated by liver biopsy, while the correlation of Agile 4 was moderate ( r = 0.535). However, the Agile 3+ and Agile 4 scores have shown high sensitivity and specificity (higher than 80% in all cases) when compared to liver biopsy. Also, there was significance in the area under the ROC curve, which was inferior than 0.5 for all cases. CONCLUSION: A good correlation was confirmed between the Agile scores and VCTE with the stages of fibrosis in MASLD individuals, classifying correctly the presence of LF and cirrhosis better than VCTE solo, with a smaller indeterminate zone.