BACKGROUND AND AIMS A simple non-invasive score, the Agile3+ score, combining liver stiffness measurement (LSM), aspartate aminotransferase/alanine aminotransferase ratio, platelet count, diabetes status, sex, and age, has been proposed for identification of advanced fibrosis in patients with suspected non-alcoholic fatty liver disease (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 (MASLD), so currently, the two terms are interchangeable. METHODS 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 24th of April 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) cut-offs. RESULTS We included 6 observational studies (total 6955 participants) with biopsy-proven NAFLD (mean age 53 [SE 4] years, mean BMI 30.9 [SE 2.3] Kg/m2, 54.0% men, prevalence of diabetes 59.6%). The pooled prevalence of advanced fibrosis (≥F3) was 42.1%. By the rule-out cut-off, 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 cut-off, 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), BMI (p<0.01), and, although not statistically significant, sex (p=0.06). CONCLUSION Our systematic review and meta-analysis suggest that Agile3+ accurately diagnoses NAFLD with advanced fibrosis and can identify patients eligible for biopsy and emerging pharmacotherapies.

中文翻译：

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AGILE3+ 评分对非酒精性脂肪肝患者晚期纤维化的诊断准确性：系统评价和荟萃分析。

背景和目的 一种简单的非侵入性评分，即 Agile3+ 评分，结合了肝脏硬度测量 (LSM)、天冬氨酸转氨酶/丙氨酸转氨酶比率、血小板计数、糖尿病状况、性别和年龄，已被提议用于识别患者的晚期纤维化疑似患有非酒精性脂肪肝（NAFLD）。我们对观察性研究进行了系统回顾和荟萃分析，以评估 Agile 3+ 评分在识别 NAFLD 和晚期纤维化患者方面的诊断准确性。最近，一项国际共识将 NAFLD 的命名改为代谢相关脂肪肝病 (MASLD)，因此目前这两个术语可以互换。方法 我们系统地检索了 MEDLINE、Ovid Embase、Scopus 和 Cochrane 图书馆电子数据库，以查找从开始到 2023 年 4 月 24 日期间以任何语言发表的全文文章。我们纳入了报告有关敏捷 3 的敏感性和特异性的数据的原始文章+ 分数，根据先前描述的排除（≤0.451）和纳入（≥0.679）截止值。结果 我们纳入了 6 项经活检证实患有 NAFLD 的观察性研究（总共 6955 名受试者）（平均年龄 53 [SE 4] 岁，平均 BMI 30.9 [SE 2.3] Kg/m2，男性 54.0%，糖尿病患病率 59.6%）。晚期纤维化（≥F3）的汇总患病率为 42.1%。根据排除截止值，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%) 。根据规则截止值，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%) 。荟萃回归分析表明，诊断准确性部分由年龄 (p<0.01)、BMI (p<0.01) 以及性别 (p=0.06)（尽管不具有统计学意义）决定。结论 我们的系统回顾和荟萃分析表明，Agile3+ 可以准确诊断伴有晚期纤维化的 NAFLD，并可以识别适合进行活检和新兴药物治疗的患者。