Abstract：
OBJECTIVE: A simple noninvasive score, the Agile 3+ score, combining liver stiffness measurement, aspartate aminotransferase/alanine aminotransferase ratio, platelet count, diabetes status, sex, and age, has been proposed for the identification of advanced fibrosis in patients with suspected NAFLD. We performed a systematic review and meta-analysis of observational studies to evaluate the diagnostic accuracy of the Agile 3+ score in identifying patients with NAFLD and advanced fibrosis. Recently, an International consensus changed the nomenclature of NAFLD into metabolic-associated steatotic liver disease, so currently, the two terms are interchangeable.
RESULTS: We systematically searched MEDLINE, Ovid Embase, Scopus, and Cochrane Library electronic databases for full-text published articles in any language from the inception to the April 24, 2023. We included original articles reporting data on the sensitivity and specificity of the Agile 3+ score, according to previously described rule-out (≤ 0.451) and rule-in (≥ 0.679) cutoffs. We included 6 observational studies (total of 6955 participants) with biopsy-proven NAFLD [mean age 53 (SE 4) years, mean body mass index 30.9 (SE 2.3) kg/m 2 , 54.0% men, prevalence of diabetes 59.6%]. The pooled prevalence of advanced fibrosis (≥ F3) was 42.1%. By the rule-out cutoff, the overall sensitivity and specificity were 88% (95% CI: 81-93%; I2 = 89.2%) and 65% (95% CI: 54-75%; I2 = 97.6%), respectively. By the rule-in cutoff, the overall sensitivity and specificity were 68% (95% CI: 57-78%; I2 =91.1%) and 87% (95% CI: 80%-92%; I2 =96.7%), respectively. Meta-regression analyses reported that the diagnostic accuracy was partly mediated by age ( p < 0.01), body mass index ( p < 0.01), and, although not statistically significant, sex ( p = 0.06).
CONCLUSIONS: Our systematic review and meta-analysis suggests that Agile 3+ accurately diagnoses NAFLD with advanced fibrosis and can identify patients eligible for biopsy and emerging pharmacotherapies.
RESULTS: We systematically searched MEDLINE, Ovid Embase, Scopus, and Cochrane Library electronic databases for full-text published articles in any language from the inception to the April 24, 2023. We included original articles reporting data on the sensitivity and specificity of the Agile 3+ score, according to previously described rule-out (≤ 0.451) and rule-in (≥ 0.679) cutoffs. We included 6 observational studies (total of 6955 participants) with biopsy-proven NAFLD [mean age 53 (SE 4) years, mean body mass index 30.9 (SE 2.3) kg/m 2 , 54.0% men, prevalence of diabetes 59.6%]. The pooled prevalence of advanced fibrosis (≥ F3) was 42.1%. By the rule-out cutoff, the overall sensitivity and specificity were 88% (95% CI: 81-93%; I2 = 89.2%) and 65% (95% CI: 54-75%; I2 = 97.6%), respectively. By the rule-in cutoff, the overall sensitivity and specificity were 68% (95% CI: 57-78%; I2 =91.1%) and 87% (95% CI: 80%-92%; I2 =96.7%), respectively. Meta-regression analyses reported that the diagnostic accuracy was partly mediated by age ( p < 0.01), body mass index ( p < 0.01), and, although not statistically significant, sex ( p = 0.06).
CONCLUSIONS: Our systematic review and meta-analysis suggests that Agile 3+ accurately diagnoses NAFLD with advanced fibrosis and can identify patients eligible for biopsy and emerging pharmacotherapies.
摘要：
目标：简单的非侵入性评分，敏捷3+得分，结合肝脏硬度测量，天冬氨酸转氨酶/丙氨酸转氨酶比值,血小板计数,糖尿病状态，性别,和年龄,已被提议用于鉴定疑似NAFLD患者的晚期纤维化。我们对观察性研究进行了系统评价和荟萃分析，以评估Agile3+评分在识别NAFLD和晚期纤维化患者中的诊断准确性。最近,一项国际共识将NAFLD的命名法改为代谢相关的脂肪变性肝病，所以目前,这两个术语是可以互换的。
结果：我们系统地搜索了MEDLINE，OvidEmbase,Scopus,和Cochrane图书馆电子数据库，用于从成立到2023年4月24日以任何语言全文发表的文章。我们纳入了报告Agile3+评分敏感性和特异性数据的原始文章，根据先前描述的排除（≤0.451）和排除（≥0.679）截止。我们纳入了6项观察性研究（共6955名参与者），其中活检证实为NAFLD[平均年龄53（SE4）岁，平均体重指数30.9（SE2.3）kg/m2，男性占54.0%，糖尿病患病率59.6%]。晚期纤维化（≥F3）的合并患病率为42.1％。通过排除截止，总体敏感性和特异性分别为88%(95%CI:81-93%;I2=89.2%)和65%(95%CI:54-75%;I2=97.6%),分别。根据规则的截止，总体敏感性和特异性分别为68％（95％CI：57-78％;I2=91.1％）和87％（95％CI：80％-92％;I2=96.7％），分别。荟萃回归分析报道，诊断准确性部分由年龄介导(p<0.01)，体重指数（p<0.01），and,虽然没有统计学意义，性别（p=0.06）。
结论：我们的系统评价和荟萃分析表明，Agile3+能够准确诊断出具有晚期纤维化的NAFLD，并能够确定符合活检和新兴药物治疗条件的患者。
结果：我们系统地搜索了MEDLINE，OvidEmbase,Scopus,和Cochrane图书馆电子数据库，用于从成立到2023年4月24日以任何语言全文发表的文章。我们纳入了报告Agile3+评分敏感性和特异性数据的原始文章，根据先前描述的排除（≤0.451）和排除（≥0.679）截止。我们纳入了6项观察性研究（共6955名参与者），其中活检证实为NAFLD[平均年龄53（SE4）岁，平均体重指数30.9（SE2.3）kg/m2，男性占54.0%，糖尿病患病率59.6%]。晚期纤维化（≥F3）的合并患病率为42.1％。通过排除截止，总体敏感性和特异性分别为88%(95%CI:81-93%;I2=89.2%)和65%(95%CI:54-75%;I2=97.6%),分别。根据规则的截止，总体敏感性和特异性分别为68％（95％CI：57-78％;I2=91.1％）和87％（95％CI：80％-92％;I2=96.7％），分别。荟萃回归分析报道，诊断准确性部分由年龄介导(p<0.01)，体重指数（p<0.01），and,虽然没有统计学意义，性别（p=0.06）。
结论：我们的系统评价和荟萃分析表明，Agile3+能够准确诊断出具有晚期纤维化的NAFLD，并能够确定符合活检和新兴药物治疗条件的患者。
