Clinical trial NCT05370053: The Availability of the Enhanced Liver Fibrosis (ELF) Test Affects the Rate of Diagnosis of Nonalcoholic Steatohepatitis (NASH) With Fibrosis in Patients Referred to Hepatology
Official title: The Availability of the Enhanced Liver Fibrosis (ELF) Test Affects the Rate of Diagnosis of Nonalcoholic Steatohepatitis (NASH) With Fibrosis in Patients Referred to Hepatology
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Fatty Liver
NAFLD
Lead sponsor: University of Kansas Medical Center
Sponsor class: OTHER
Collaborators: name: Gilead Sciences
First posted: 2022-05-11
Enrollment: 450
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: During the hepatology evaluation for elevated liver enzymes or fatty liver at the University of Kansas Medical Center, the hepatologists (8 total) make a clinical decision on whether patients shall receive vibration-controlled transient elastography (VCTE). At the end of the clinic visit, patients were enrolled and randomized to receiving an enhanced liver fibrosis (ELF) test. If randomized to receiving the ELF testing, the hepatologist will receive the ELF result within 1 week. The hepatologist is free to the clinical information at hand to make clinical decisions. Possible decisions include: 1)defer liver biopsy without making a clinical diagnosis of cirrhosis 2)order liver biopsy, where the result may show F0-2 fibrosis, 3)order liver biopsy, where the result may show F3-4 fibrosis, 4)clinical diagnosis of cirrhosis without liver biopsy
Primary purpose: SCREENING

Brief summary: Background: During the hepatology evaluation, vibration-controlled transient elastography (VCTE) is often used as a clinical decision aid to target high-risk patients for liver biopsy. The enhanced liver fibrosis (ELF) test is expected to be approved in the US. We tested the hypothesis that making the ELF results available to the treating hepatologist will result in more appropriate and targeted use of liver biopsy in patients with elevated liver enzymes or fatty liver, and will result in more cases of advanced fibrosis/cirrhosis being diagnosed. Methods: During the hepatology evaluation for elevated liver enzymes or fatty liver at the University of Kansas Medical Center, the hepatologists (8 total) make a clinical decision on whether patients shall receive VCTE. At the end of the clinic visit, patients were enrolled and randomized to receiving an ELF test. Patients with liver biopsy within the last five years or decompensated cirrhosis were excluded. The primary outcome is the rate of a diagnosis of F3-4 fibrosis based on liver biopsy or clinical diagnosis of cirrhosis with the initiation of hepatocellular carcinoma surveillance. Four hundred fifty patients are to be enrolled over two years.


Eligibility criteria: Inclusion Criteria:

* Patients from hepatology clinic undergoing new evaluation for NAFLD.

Exclusion Criteria:

* Patients with liver biopsy within the last five years or decompensated cirrhosis were excluded. Patients known to have other liver diseases were also excluded. Patients consuming \> 14 drinks in the past 6 months were excluded. Patients may be subsequently found to have positive viral or autoimmune serologies after enrollment because the serology result is typically not available at the time of enrollment. These patients will be excluded from the analysis.

Primary outcomes:
measure: A diagnosis of F3-4 fibrosis based on liver biopsy or clinical diagnosis of cirrhosis.
timeFrame: 2 years
Secondary outcomes:
Other outcomes:
Locations:
city: Kansas City
country: United States
facility: University of Kansas Medical Center
state: Kansas
Study officials:
References: