Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities

BACKGROUND 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,VCTEbased 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).AIM To clarify the significance of VCTE-based scoring systems to narrow the high-risk group of NAFLD patients with comorbidities.METHODS 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.RESULTS 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.CONCLUSION Agile 3+and Agile 4 are useful to narrow the NAFLD patient group,in which patients may have HCC and/or EGV.