Clinical trial NCT05880173: SCREaning of Advanced Liver Fibrosis Using Non-Invasive Tests in General Population
Official title: SCREaning of Advanced Liver Fibrosis Using Non-Invasive Tests in General Population
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Screening
Advanced Liver Fibrosis
Keywords: Screening
advanced liver fibrosis
non-invasive tests
Lead sponsor: University Hospital, Angers
Sponsor class: OTHER_GOV
First posted: 2023-05-30
Enrollment: 502
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: SCREENING

Brief summary: The main objective of the study is to evaluate the pertinence of initiating screening for advanced hepatic fibrosis after a FIB4 result \> 2.67 automatically calculated in the local laboratory and followed by a specialized hepatic evaluation.

Detailed description: Chronic liver diseases are insidious diseases characterized by inflammation of the liver parenchyma responsible for a progressive accumulation of fibrosis until cirrhosis and hepatocellular carcinoma (HCC). Cirrhosis and HCC are respectively the 11th and 16th most frequent causes of death in the world, and are responsible for 2 million deaths each year. Cirrhosis and HCC are most often diagnosed too late with a median survival of 18-24 months.

The degree of hepatic fibrosis is the main predictive factor of the risk of hepatic complications (decompensation of cirrhosis, HCC) in chronic liver diseases.

Hepatic fibrosis is described in 5 stages from F0 (no fibrosis) to F4 (cirrhosis). It is well accepted that patients with advanced hepatic fibrosis (F3 and F4) are at the highest risk of developing complications of cirrhosis and/or HCC. It is therefore necessary to identify these patients in order to offer them specialized management.

Tests have been developed over the last two decades for the non-invasive diagnosis of liver fibrosis, essentially the fibrosis blood test (FIB4) and liver elastometry devices (fibroScan). The FIB4 is a simple blood test that is easy to calculate from the usual inexpensive blood parameters (ASAT, ALAT, platelets). The recommendations of French, European and American scientific societies are unanimous and recommend targeted screening for liver fibrosis in patients with hepatic risk factors using FIB4 as a first line test.

To facilitate screening by general practitioners, several French consortia of medical analysis laboratories have set up routine calculation of FIB4 on all biological tests, including platelets, AST and ALT, without regard to the patient's risk factors for liver disease. This approach is not in concordance with the recommendations of the scientific societies (targeted screening in patients with hepatic risk factors) and needs to be evaluated.

The purpose of this study is to evaluate if the procedure for diagnosing hepatic fibrosis implemented by some local laboratories and based on an automated calculation of FIB4 is pertinent.

Eligibility criteria: Inclusion Criteria:

* Age between 18 and 75 years
* Blood sample taken at a medical testing laboratory selected for the study.
* Biology without high risk of false positive result for FIB4 (AST and ALT ≤ 300 IU/l ; Platelets ≥ 50 G/l and \< 500 G/l.)
* FIB4 \> 2.67 after automatic calculation in the medical laboratory less than 3 months old
* Signature of informed consent to participate in the study

Exclusion Criteria:

* Ongoing specialized follow-up for a chronic liver disease
* Difficulty understanding the French language
* Pregnant women, breastfeeding or parturient women
* Persons suspended from liberty by judicial or administrative decision
* Persons under legal protection
* Persons unable to express their consent
* Non affiliation to a social security system

Primary outcomes:
measure: Proportion of advanced hepatic fibrosis.
timeFrame: 3 months maximum
Secondary outcomes:
measure: Determine the rate of patients requiring second-line evaluation by elastometry
timeFrame: 3 months maximum
measure: Determine the rate of patients requiring management by a liver disease specialist.
timeFrame: 3 months maximum
measure: Determine the average cost spent on a patient diagnosed with advanced liver fibrosis
timeFrame: 3 months maximum
measure: Determine patient adherence to the screening procedure
timeFrame: 3 months maximum
measure: Determine risk factors associated with advanced liver fibrosis, and consequently the subgroup of patients for whom screening should be a priority
timeFrame: 3 months maximum
measure: Determine the rate of patients with a significant liver complication in the population of patients with risk factors
timeFrame: 3 months maximum
Other outcomes:
Locations:
city: Angers
country: France
facility: Chu Angers
city: Angers
country: France
facility: Chu Bordeaux
city: Grenoble
country: France
facility: Chu Grenoble Alpes
city: Lens
country: France
facility: Centre Hospitalier de Lens
city: Marseille
country: France
facility: Hopital Saint Joseph
city: Nancy
country: France
facility: Chu Nancy
Study officials:
References: