Lipids & metabolic liver disease
Diagnostic accuracy of Agile‐4 score for liver cirrhosis in patients with metabolic dysfunction‐associated steatotic liver disease. A systematic review and meta‐analysis of diagnostic test accuracy studies
Authors' conclusion
Agile-4 score performs well for ruling-in/out liver cirrhosis in MASLD patients. Owing to the relatively low PPV, sequential application of the Agile-4 after fibrosis-4 index (FIB-4) testing might further enhance its performance.
Study context
- Population
- Patients with MASLD; liver biopsy as reference standard for cirrhosis; searches up to May 2024
- Participants
- 6,037 patients7 studies
- Comparison
- Agile-4 ≥0.565 vs Agile-4 <0.251
- Outcome
- Pooled sensitivity and specificity of Agile-4 for ruling-in/out liver cirrhosis
Methodological detailsbivariate random-effect models, QUADAS-2 risk of bias assessment, Most studies at high or unclear risk of bias (patient selection; blinding of Agile-4 interpretation to biopsy)
- Bivariate random-effect models
- QUADAS-2 risk of bias assessment
- Most studies at high or unclear risk of bias (patient selection; blinding of Agile-4 interpretation to biopsy)
Pooled result
As reported in the abstract
Cirrhosis vs liver biopsy
| Strategy | Summary sensitivity | Pooled specificity | PPV (assumed prevalence 30%) | NPV (assumed prevalence 30%) |
|---|---|---|---|---|
| Agile-4 ≥0.565 | — not stated in the abstract | 0.93 (95% CI, 0.86-0.97) | 80% | — not stated in the abstract |
| Agile-4 <0.251 | 0.90 (0.80-0.95) | — not stated in the abstract | — not stated in the abstract | 95% |
Summary sensitivity
Agile-4 ≥0.565— not stated in the abstract
Agile-4 <0.2510.90 (0.80-0.95)
Pooled specificity
Agile-4 ≥0.5650.93 (95% CI, 0.86-0.97)
Agile-4 <0.251— not stated in the abstract
PPV (assumed prevalence 30%)
Agile-4 ≥0.56580%
Agile-4 <0.251— not stated in the abstract
NPV (assumed prevalence 30%)
Agile-4 ≥0.565— not stated in the abstract
Agile-4 <0.25195%
— not stated in the abstract
Original publication
Diagnostic accuracy of Agile‐4 score for liver cirrhosis in patients with metabolic dysfunction‐associated steatotic liver disease. A systematic review and meta‐analysis of diagnostic test accuracy studies. Diabetes Obes Metab. Published 20 December 2024. doi:10.
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