{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T13:34:41Z","timestamp":1793799281999,"version":"4.6.1"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,4,16]]},"abstract":"\n Importance<\/jats:title>\n Metabolic dysfunction\u2013associated steatotic liver disease (MASLD) is currently the most common chronic liver disease worldwide. It is important to develop noninvasive tests to assess the disease severity and prognosis.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To study the prognostic implications of baseline levels and dynamic changes of the vibration-controlled transient elastography (VCTE)\u2013based scores developed for the diagnosis of advanced fibrosis (Agile 3+) and cirrhosis (Agile 4) in patients with MASLD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study included data from a natural history cohort of patients with MASLD who underwent VCTE examination at 16 tertiary referral centers in the US, Europe, and Asia from February 2004 to January 2023, of which the data were collected prospectively at 14 centers. Eligible patients were adults aged at least 18 years with hepatic steatosis diagnosed by histologic methods (steatosis in \u22655% of hepatocytes) or imaging studies (ultrasonography, computed tomography or magnetic resonance imaging, or controlled attenuation parameter \u2265248 dB\/m by VCTE).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was liver-related events (LREs), defined as hepatocellular carcinoma or hepatic decompensation (ascites, variceal hemorrhage, hepatic encephalopathy, or hepatorenal syndrome), liver transplant, and liver-related deaths. The Agile scores were compared with histologic and 8 other noninvasive tests.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 16\u202f603 patients underwent VCTE examination at baseline (mean [SD] age, 52.5 [13.7] years; 9600 [57.8%] were male). At a median follow-up of 51.7 (IQR, 25.2-85.2) months, 316 patients (1.9%) developed LREs. Both Agile 3+ and Agile 4 scores classified fewer patients between the low and high cutoffs than most fibrosis scores and achieved the highest discriminatory power in predicting LREs (integrated area under the time-dependent receiver-operating characteristic curve, 0.89). A total of 10\u202f920 patients (65.8%) had repeated VCTE examination at a median interval of 15 (IQR, 11.3-27.7) months and were included in the serial analysis. A total of 81.9% of patients (7208 of 8810) had stable Agile 3+ scores and 92.6% of patients (8163 of 8810) had stable Agile 4 scores (same risk categories at both assessments). The incidence of LREs was 0.6 per 1000 person-years in patients with persistently low Agile 3+ scores and 30.1 per 1000 person-years in patients with persistently high Agile 3+ scores. In patients with high Agile 3+ score at baseline, a decrease in the score by more than 20% was associated with substantial reduction in the risk of LREs. A similar trend was observed for the Agile 4 score, although it missed more LREs in the low-risk group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Findings of this study suggest that single or serial Agile scores are highly accurate in predicting LREs in patients with MASLD, making them suitable alternatives to liver biopsy in routine clinical practice and in phase 2b and 3 clinical trials for steatohepatitis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.1447","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T11:02:02Z","timestamp":1711018922000},"page":"1287","source":"Crossref","is-referenced-by-count":258,"title":["Vibration-Controlled Transient Elastography Scores to Predict Liver-Related Events in Steatotic Liver Disease"],"prefix":"10.1001","volume":"331","author":[{"given":"Huapeng","family":"Lin","sequence":"first","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry Cheuk-Fung","family":"Yip","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Tsochatzis","sequence":"additional","affiliation":[{"name":"University College London Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Petta","sequence":"additional","affiliation":[{"name":"Sezione di Gastroenterologia, PROMISE, University of Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Bugianesi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O.U. Citt\u00e0 della Salute e della Scienza di Torino, University of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Yoneda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Hua","family":"Zheng","sequence":"additional","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Hagstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medicine, Huddinge, Karolinska Institutet, Sweden"},{"name":"Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Boursier","sequence":"additional","affiliation":[{"name":"Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France"},{"name":"HIFIH Laboratory, SFR ICAT 4208, Angers University, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"Calleja","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Boon-Bee","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wah-Kheong","family":"Chan","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocio","family":"Gallego-Dur\u00e1n","sequence":"additional","affiliation":[{"name":"Digestive Diseases Unit and CIBERehd, Virgen Del Roc\u00edo University Hospital, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun J.","family":"Sanyal","sequence":"additional","affiliation":[{"name":"Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, VCU School of Medicine, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"de L\u00e9dinghen","sequence":"additional","affiliation":[{"name":"Centre d\u2019Investigation de la Fibrose H\u00e9patique, Haut-L\u00e9v\u00eaque Hospital, University Hospital of Bordeaux, Pessac, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip N.","family":"Newsome","sequence":"additional","affiliation":[{"name":"National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Gao","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Cast\u00e9ra","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, UMR1149 (CRI), INSERM, Paris, France; 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