Background: The applicability of the Agile 3+ score to patients with CHB-MASLD receiving antiviral therapy remains unexplored. Our objective was to explore the diagnostic and prognostic performances of the Agile 3+ score in patients with CHB-MASLD.
Methods: This retrospective cohort study included consecutively enrolled patients with CHB and concurrent MASLD from 2014 to 2020. In Part 1, we evaluated the performance of the Agile 3+ score in predicting advanced fibrosis. In Part 2, the Agile 3+ score was applied to a follow-up cohort to assess its correlation with liver-related events.
Results: Among the 2492 patients evaluated by vibration-controlled transient elastography, 103 patients with CHB and hepatic steatosis were included in the biopsy cohort, and 716 patients were included in the follow-up cohort. The Agile 3+ score had the highest AUROC of 0.916 for the prediction of advanced fibrosis, outperforming the FIB-4 score (0.845), NFS (0.838), and APRI (0.726). In predicting liver-related events (LREs), the AUROC of the Agile 3+ score was also significantly higher (0.795 at 3 years, 0.809 at 5 years, and 0.834 at 8 years) than those of the other noninvasive tests. When the recommended cutoffs (0.451 and 0.679) were applied for MASLD risk stratification, the high-risk group (HR = 13.61) and intermediate-risk group (HR = 3.53) had significantly greater risks of LREs than the low-risk group.
Conclusion: In patients with CHB and concurrent MASLD receiving antiviral therapy, the Agile 3+ score effectively identifies advanced fibrosis and predicts LRE risk, supporting its clinical utility in this population.
Keywords: chronic hepatitis B; hepatic steatosis; liver fibrosis; noninvasive test.
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