Prognostic Accuracy of Transient Elastography-Based Predictors in Diabetes and Obesity: A Multicenter International Cohort Study.

IF 2.5 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Digestive Diseases and Sciences Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI:10.1007/s10620-024-08635-y

Venkata Sai Jayakrishna Jasty, Esteban Urias, Kai Le Ashley Tiong, Majd Bassam Aboona, Michael Song, Claire Faulkner, Pooja Devan, Jean Ee Neo, Karn Wijarnpreecha, Yu Jun Wong, Vincent Lingzhi Chen

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Abstract

Background/aims: Liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) is recommended for risk stratification of patients with nonalcoholic fatty liver disease (NAFLD). More recently, AGILE3 + and AGILE4 have combined LSM with clinical parameters to identify patients with advanced fibrosis and cirrhosis, respectively. However, there are limited data on prognostic performance of these scores in key at-risk subgroups such as those with diabetes and obesity compared to LSM alone.

Methods: This is a retrospective cohort study including 1903 adult patients with NAFLD from tertiary care centers in the United States and Singapore undergoing VCTE between 2015 and 2022. Primary predictors were FAST, LSM, AGILE3 + , and AGILE4 scores and the primary outcome was liver-related events (LRE). Patients were further stratified by diabetes and obesity status. Prognostic performance was measured using the time-dependent area under the receiver operating characteristic curve (tAUC) at 5 years.

Results: In total, 25 LRE occurred and the overall incidence rate of LRE was 4.4 per 1000 person-years. tAUC for predicting LRE in the overall group was significantly higher with AGILE3 + (0.94 [95% CI: 0.90-0.98]) and AGILE4 (0.94 [95% CI: 0.90-0.98]) compared to LSM (0.87 [95% CI: 0.80-0.94]) (p = 0.001 and 0.009, respectively) and FAST (0.73 [95% CI: 0.59-0.86]) (p < 0.001 for both). Similarly, tAUC was significantly higher in those with T2D for AGILE3 + compared to LSM (0.92 vs 0.86, respectively) (p = 0.015) and FAST (0.92 vs 0.73, respectively) (p = 0.008). Among people with obesity, tAUC was significantly higher for AGILE3 + compared to LSM (0.95 vs 0.89, respectively) (p = 0.005) and FAST (0.95 vs 0.76, respectively) (p = 0.0035). Though AGILE4 had a higher tAUC in these subgroups compared to LSM, it did not reach statistical significance.

Conclusion: AGILE3 + significantly outperforms LSM and FAST for predicting LRE in patients with NAFLD including in those with diabetes or obesity.

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基于瞬态弹性成像的糖尿病和肥胖症预测指标的预后准确性：一项多中心国际队列研究。

背景/目的：通过振动控制瞬态弹性成像（VCTE）测量肝脏硬度（LSM）被推荐用于非酒精性脂肪肝（NAFLD）患者的风险分层。最近，AGILE3 + 和 AGILE4 将 LSM 与临床参数相结合，分别用于识别晚期纤维化和肝硬化患者。然而，与单独使用 LSM 相比，这些评分在糖尿病和肥胖等主要高危亚群中的预后表现数据有限：这是一项回顾性队列研究，包括美国和新加坡三级医疗中心的 1903 名非酒精性脂肪肝成年患者，他们在 2015 年至 2022 年期间接受了 VCTE。主要预测指标为 FAST、LSM、AGILE3 + 和 AGILE4 评分，主要结果为肝脏相关事件（LRE）。根据糖尿病和肥胖状况对患者进行进一步分层。预后表现采用5年后受体操作特征曲线下的时间依赖性面积（tAUC）来衡量：结果：总共发生了 25 例 LRE，LRE 的总发生率为每千人年 4.4 例。AGILE3 + 预测总体组 LRE 的 tAUC 明显更高（0.94[95%CI：0.90-0.98]）和 AGILE4（0.94[95%CI：0.90-0.98]）明显高于 LSM（0.87[95%CI：0.80-0.94]）（p = 0.001 和 0.009，分别为 0.001 和 0.009）和 FAST（0.73[95%CI：0.59-0.86]）（p 结论：AGILE3 + 和 AGILE4 预测 LRE 的 tAUC 明显高于 LSM（0.87[95%CI：0.80-0.94]）和 FAST（0.73[95%CI：0.59-0.86]）：在预测非酒精性脂肪肝患者（包括糖尿病或肥胖患者）的LRE方面，AGILE3 +明显优于LSM和FAST。

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来源期刊

Digestive Diseases and Sciences 医学-胃肠肝病学

CiteScore

6.40

自引率

3.20%

发文量

420

审稿时长

1 months

期刊介绍： Digestive Diseases and Sciences publishes high-quality, peer-reviewed, original papers addressing aspects of basic/translational and clinical research in gastroenterology, hepatology, and related fields. This well-illustrated journal features comprehensive coverage of basic pathophysiology, new technological advances, and clinical breakthroughs; insights from prominent academicians and practitioners concerning new scientific developments and practical medical issues; and discussions focusing on the latest changes in local and worldwide social, economic, and governmental policies that affect the delivery of care within the disciplines of gastroenterology and hepatology.