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Updated: Jan 13, 2026
Optimized Analysis of In Vivo and In Vitro Hepatic Steatosis
Published on: March 11, 2017
Agile 3+ Index Is Independently Associated With Cardiovascular Diseases in Patients With Metabolic
Yan Li1, Minglan Yang1, Jiang Yue1
1Department of Endocrinology and Metabolism, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The Agile 3+ score, recently developed based on transient elastography measurements, transaminase ratios, and metabolic parameters, effectively assesses fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the association between Agile 3+ and cardiovascular diseases (CVD) in MASLD and to compare its predictive performance with Agile 4, Fibrosis-4 (FIB-4), and FibroScan aspartate aminotransferase (FAST).
Methods:
We analysed data in 3198 patients with MASLD during the 2017-March 2020 prepandemic from National Health and Nutrition Examination Survey. The associations between Agile 3+ and CVD were assessed using univariate and multivariable logistic regression models. Predictive accuracy was evaluated via receiver operating characteristic curves and decision curve analysis (DCA).
Results:
Among 3198 patients with MASLD, 385 (12.0%) had CVD. After adjusting for confounders, a dose-dependent relationship was observed between Agile 3+ and CVD risk: compared to the reference group, the odds of CVD increased by 58% in the 0.45-0.68 group (OR 1.58, 95%CI 1.13-2.20, p = 0.008) and by 78% in the ≥ 0.68 group (OR 1.78, 95%CI 1.22-2.59, p = 0.003). In the context of CVD risk prediction, Agile 3+ and FIB-4 achieved the highest AUC (0.71), outperforming Agile 4 (0.64) and FAST (0.51). DCA revealed that Agile 3+ provided superior net benefit within the 20%-40% CVD risk threshold range. Furthermore, subgroup and sensitivity analyses further confirmed the robustness of the results.
Conclusions:
Agile 3+ is independently associated with CVD in patients with MASLD and demonstrates better predictive performance than Agile 4, FIB-4, and FAST scores.
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