Screening in Primary Care of Advanced Liver Fibrosis in NAFLD and/or Alcoholic Patients (IMPROVE Study)

University Hospital, Angers282 enrolled

Overview

The main objective is to determine the performance of the simple eLIFT blood test for advanced liver fibrosis screening in NAFLD and/or alcoholic patients in primary care.

eLIFT, is a new blood fibrosis test specifically dedicated for general practitioners with simple parameters and easy "by head" calculation. Using the recommended cut-offs (eLIFT ≥8), eLIFT sensitivity was 86%. This result position eLIFT an as interesting tool for the screening of advanced liver fibrosis in large populations. As our preliminary results come from very selected patients, i.e. patients from tertiary centres who underwent a liver biopsy, we now need to evaluate in the real condition of primary care setting whether the use of eLIFT will help general practitioners to screen advanced liver fibrosis in their asymptomatic NAFLD and alcoholic patients.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

282

Conditions

NAFLD Alcohol-Related Disorder Liver Fibrosis

Interventions

e-LIFTDIAGNOSTIC_TEST

Diagnostic procedure: elastography devices, blood tests (e-LIFT), liver biopsy if necessary (elstometry ≥ 8 kPa and \< 15 kPa)

Eligibility

Sex: ALLMin age: 40 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * NAFLD and/or alcoholic patient defined by ≥1 of the following criteria: * Excessive alcohol consumption: \>210 g/week (men), \>140 g/week (women) * Type 2 diabetes * ≥2 metabolic factors among: 1/BMI ≥25kg/m2; 2/elevated blood pressure (antihypertensive drug, or systolic blood pressure ≥130mmHg, or diastolic blood pressure ≥85mmHg), 3/dyslipidemia (lipid-lowering drug, or HDL cholesterol \<40mg/dl (men) / \<50mg/dl (women), or triglycerides ≥150mg/dl); 4/hyperferritinemia (\>300 ng/ml (men)/\>200 ng/ml (women)) * Bright liver at ultrasonography without steatosis-inducing drug * Obtaining the signature of the consent to participate in the study Exclusion Criteria: * Already ongoing specialized follow-up for a chronic liver disease * Altered health status with poor short-term prognosis, not compatible with a screening procedure * Decompensated cirrhosis (hepatic encephalopathy, jaundice, ascites, variceal bleeding, hepatorenal syndrome) * Acute infection * Inadequate understanding of the French language * Pregnant, breastfeeding or parturient women * Persons deprived of their liberty by judicial or administrative decision * Persons subject to legal protection measures * Persons unable to consent * Refusal to participate

Locations (1)

Dr Adrien LANNES

Angers, France

Outcomes

Primary Outcomes

e-LIFT negative predictive value for the diagnosis of advanced hepatic fibrosis

The primary outcome of the study is the negative predictive value for the diagnosis of advanced hepatic fibrosis (i.e., the rate of patients who do not actually have advanced hepatic fibrosis when the eLIFT test is \<8)

Time frame: 1 day

Secondary Outcomes

sensibility of the eLIFT test

Rate of patients with an eLIFT test ≥8 among patients with advanced hepatic fibrosis

Time frame: 1 day

specificity and positive predictive value of the eLIFT test

Rate of patients with an eLIFT test ≥8 but without a final diagnosis of advanced hepatic fibrosis (false positives), specificity (i. e. the rate of patients with an eLIFT test \< 8 among patients without advanced hepatic fibrosis) and positive predictive value of the eLIFT test (i. e. the rate of patients with effective advanced hepatic fibrosis when the eLIFT test is ≥ 8)

Time frame: 1 day

rate of liver complications among patients with an eLIFT test ≥ 8

Rate of patients with hepatocellular carcinoma (diagnosed by recommended radiological criteria or liver biopsy); rate of patients with gastroesophageal varices at risk of bleeding diagnosed by gastrointestinal endoscopy (according to Baveno VI rules: medium to large or small varices with red signs) among patients with an eLIFT test is ≥ 8

Time frame: 1 day

performance of e-LIFT test in subgroup analysis

Rates of patients with advanced hepatic fibrosis, hepatocellular carcinoma rate, gastroesophageal varicose vein rate at risk of bleeding, eLIFT test rate ≥8, sensitivity, specificity, negative predictive value, positive predictive value in each subgroup (NAFLD, alcohol and NAFLD + alcohol)

Time frame: 1 day

Data from ClinicalTrials.gov

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