Title: The Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-
Related Advanced Fibrosis and Cirrhosis in the United States Population Utilizing AGILE 3+
and AGILE 4 Scores: Analysis of the NHANES 2017-2018 Cycle
Version: 0 Date: 21 Nov 2023
Reviewer's report:
I'm very grateful for the opportunity to review this interesting manuscript.
Drs. Alkhouri , Noureddin, et al examine the Prevalence of Nonalcoholic Steatohepatitis
(NASH)-Related Advanced Fibrosis and Cirrhosis in the United States Population Utilizing
Methods:
AGILE 3 + and AGILE 4 + Scores in the NHANES 2017–2018 Cycle.
1244 adults were included in the final analysis. NAFLD was defined with CAP score > 248
dB/m. NAFLD subjects with AGILE 3 + score of # 0.68 and AGILE4 + score of # 0.57 were
considered to have advanced fibrosis and cirrhosis; respectively. AGILE3 + of 0.45–0.67 and
AGILE4 + of 0.25–0.57 were grey zones, whereas AGILE 3 + < 0.45 and AGILE4 + < 0.25 were
considered a rule-out.
Results:
Based on AGILE3+, 80.3% of the NAFLD population were at low risk for AF and 11.5% were
in grey zone. The prevalence of AF due to NAFLD was 8.1% corresponding to 4.5M Americans.
Based on AGILE4 + score, 96.5% of the NAFLD population were at low risk for cirrhosis and
2.4% were in the grey zone. The prevalence of NASH-cirrhosis was 1.1% corresponding to
610,000 Americans.
This study is the first to report the prevalence of AF and cirrhosis using AGILE3+ and AGILE4+
scores in the US population. This information must be helpful to clinicians, trialists, and
stakeholders.
Comments to transmit.
I've noticed that a CAP>248 instead of 285 was used to identify participants with NAFLD.
Although a CAP>248 is acceptable, I wonder if the authors can elaborate on why they chose
this cutoff.  Perhaps, a sensitivity analysis including a CAP>285 to identify NAFLD would be
reasonable.
Title: The Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-
Related Advanced Fibrosis and Cirrhosis in the United States Population Utilizing AGILE 3+
and AGILE 4 Scores: Analysis of the NHANES 2017-2018 Cycle
Version: 0 Date: 21 Nov 2023
Reviewer's report:
I'm very grateful for the opportunity to review this interesting manuscript.
Drs. Alkhouri , Noureddin, et al examine the Prevalence of Nonalcoholic Steatohepatitis
(NASH)-Related Advanced Fibrosis and Cirrhosis in the United States Population Utilizing
Methods:
AGILE 3 + and AGILE 4 + Scores in the NHANES 2017–2018 Cycle.
1244 adults were included in the final analysis. NAFLD was defined with CAP score > 248
dB/m. NAFLD subjects with AGILE 3 + score of # 0.68 and AGILE4 + score of # 0.57 were
considered to have advanced fibrosis and cirrhosis; respectively. AGILE3 + of 0.45–0.67 and
AGILE4 + of 0.25–0.57 were grey zones, whereas AGILE 3 + < 0.45 and AGILE4 + < 0.25 were
considered a rule-out.
Results:
Based on AGILE3+, 80.3% of the NAFLD population were at low risk for AF and 11.5% were
in grey zone. The prevalence of AF due to NAFLD was 8.1% corresponding to 4.5M Americans.
Based on AGILE4 + score, 96.5% of the NAFLD population were at low risk for cirrhosis and
2.4% were in the grey zone. The prevalence of NASH-cirrhosis was 1.1% corresponding to
610,000 Americans.
This study is the first to report the prevalence of AF and cirrhosis using AGILE3+ and AGILE4+
scores in the US population. This information must be helpful to clinicians, trialists, and
stakeholders.
Comments to transmit.
I've noticed that a CAP>248 instead of 285 was used to identify participants with NAFLD.
Although a CAP>248 is acceptable, I wonder if the authors can elaborate on why they chose
this cutoff.  Perhaps, a sensitivity analysis including a CAP>285 to identify NAFLD would be
reasonable.
Please review this paper.
user
Title: The Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-
Related Advanced Fibrosis and Cirrhosis in the United States Population Utilizing AGILE 3+
and AGILE 4 Scores: Analysis of the NHANES 2017-2018 Cycle
Version: 0 Date: 21 Nov 2023
Reviewer's report:
I'm very grateful for the opportunity to review this interesting manuscript.
Drs. Alkhouri , Noureddin, et al examine the Prevalence of Nonalcoholic Steatohepatitis
(NASH)-Related Advanced Fibrosis and Cirrhosis in the United States Population Utilizing
Methods:
AGILE 3 + and AGILE 4 + Scores in the NHANES 2017–2018 Cycle.
1244 adults were included in the final analysis. NAFLD was defined with CAP score > 248
dB/m. NAFLD subjects with AGILE 3 + score of # 0.68 and AGILE4 + score of # 0.57 were
considered to have advanced fibrosis and cirrhosis; respectively. AGILE3 + of 0.45–0.67 and
AGILE4 + of 0.25–0.57 were grey zones, whereas AGILE 3 + < 0.45 and AGILE4 + < 0.25 were
considered a rule-out.
Results:
Based on AGILE3+, 80.3% of the NAFLD population were at low risk for AF and 11.5% were
in grey zone. The prevalence of AF due to NAFLD was 8.1% corresponding to 4.5M Americans.
Based on AGILE4 + score, 96.5% of the NAFLD population were at low risk for cirrhosis and
2.4% were in the grey zone. The prevalence of NASH-cirrhosis was 1.1% corresponding to
610,000 Americans.
This study is the first to report the prevalence of AF and cirrhosis using AGILE3+ and AGILE4+
scores in the US population. This information must be helpful to clinicians, trialists, and
stakeholders.
Comments to transmit.
I've noticed that a CAP>248 instead of 285 was used to identify participants with NAFLD.
Although a CAP>248 is acceptable, I wonder if the authors can elaborate on why they chose
this cutoff.  Perhaps, a sensitivity analysis including a CAP>285 to identify NAFLD would be
reasonable.
assistant