Screening At-risk Populations for Hepatic Fibrosis With Non-invasive Markers
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 6,500
- 试验地点
- 1
- 主要终点
- Liver-related outcomes
研究概览
简要总结
Prospective screening study at Odense University Hospital to assess the effect of transient elastography and other serum and imaging markers of liver fibrosis to detect advanced fibrosis (Kleiner Fibrosis score F3-F4) in patients at risk of non-alcoholic fatty liver disease, alcoholic fatty liver disease, with a control group of participants recruited from the general population.
详细描述
This protocol describes a prospective screening study at Odense University Hospital, Department of Gastroenterology and Hepatology. The investigators will use liver stiffness measurements with transient elastography to screen 3000 participants from at-risk populations and 3500 participants from the general population for advanced liver fibrosis. At-risk is defined as either (A) a prior or current alcohol overuse (≥21 units/week for men and ≥14 units/week for women) for more than 5 years, or (B) presence of the metabolic syndrome with or without concomitant type 2 diabetes mellitus.
The study goal is to evaluate the aptitude of transient elastography as a screening tool for advanced liver fibrosis, based on analyses of benefit, harm, detection rate, technical applicability and prognostic potential. Secondary aims are to compare novel serum markers of liver fibrosis as potential screening tools against transient elastography: The Enhanced Liver Fibrosis test, neoepitope markers of extracellular matrix turnover, cytokeratin-18 based markers and indirect indices of fibrosis from algorithms combining routine liver blood test. Screened participants with elevated liver stiffness (≥8.0 kiloPascal; estimated 400 participants with alcoholic liver disease, 400 participants with non-alcoholic fatty liver disease and 280 participants from the general population) will be investigated with 2-dimensional shear-wave elastography and abdominal ultrasonography and a liver biopsy to confirm or reject presence of advanced fibrosis.
All participants with a positive screening elastography will be invited for repeated liver stiffness measurements and serum fibrosis markers after a minimum of one year from inclusion.
Participants at risk of alcoholic and non-alcoholic liver disease, independent of liver stiffness measurement at inclusion, will be invited for repeated liver stiffness measurements and serum fibrosis markers after a minimum of one year from inclusion. At-risk participants with elevated liver stiffness measurements at a follow-up visit (>6.0 kiloPascal) will be offered a liver biopsy, however no earlier than two years after the index biopsy.
All participants will be followed for 10 years to assess liver-related outcomes and all-course mortality.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 30 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients are eligible for screening if the following inclusion criteria are fulfilled:
- •Age 30-75 years (except the general population, which should be aged 40-75)
- •Informed consent to study investigations
- •Ability to read and write Danish AND (only at-risk patients)
- •Prior or current alcohol overuse, defined as an average intake of ≥24 grams/day (14 units/week) for women and ≥36 grams/day (21 units/week) for men, for at least 5 years; OR
- •Presence of the metabolic syndrome defined by central obesity plus any two of the following four metabolic risk factors: (a) raised triglycerides, (b) reduced HDL cholesterol, (c) raised blood pressure and (d) raised fasting plasma glucose;[38] OR
- •Type 2 diabetes mellitus defined by either fasting plasma glucose ≥7 mmol/L, HbA1c ≥48 mmol/mol, a random plasma glucose ≥11.1 mmol/L in the presence of classic diabetes or an oral glucose tolerance test with fasting plasma glucose ≥7.0 mmol/L and/or 2 hour plasma glucose ≥11.1 mmol/L.
排除标准
- •We will exclude patients from screening in case of:
- •Evidence of decompensated liver disease, defined by clinically obvious ascites, overt hepatic encephalopathy, jaundice or large esophageal varices with/without variceal bleeding.
- •Known concurrent liver disease other than ALD and NAFLD.
- •Cancer or other debilitating disease with an expected survival of less than 12 months.
- •Inability to comply with the study protocol.
- •In screened patients with liver stiffness ≥8 kPa we will abstain from a liver biopsy in case of:
- •Contraindications for a percutaneous liver biopsy
- •Severe alcoholic hepatitis or other hepatic inflammation evidenced by transaminase elevation of more than three times the upper limit of normal.
- •Hepatic congestion or bile duct dilation evidenced by ultrasound.
- •Decrease of TE below 6.0 kPa from screening to time of planned liver biopsy.
研究组 & 干预措施
Liver stiffness measurement
Transient elastography in fasting state
干预措施: Omics markers (Diagnostic Test)
Liver stiffness measurement
Transient elastography in fasting state
干预措施: Cytokeratin 18 (Diagnostic Test)
Liver stiffness measurement
Transient elastography in fasting state
干预措施: transient elastography (Diagnostic Test)
Liver stiffness measurement
Transient elastography in fasting state
干预措施: Enhanced liver fibrosis test (Diagnostic Test)
Liver stiffness measurement
Transient elastography in fasting state
干预措施: Indirect serum markers of liver fibrosis (Diagnostic Test)
Liver stiffness measurement
Transient elastography in fasting state
干预措施: Direct serum markers of liver fibrosis (Diagnostic Test)
Liver stiffness measurement
Transient elastography in fasting state
干预措施: LiverTRAIL (Diagnostic Test)
结局指标
主要结局
Liver-related outcomes
时间窗: 10 years
Number of liver-related clinical outcomes during 10 years of follow up after the first screened patient, compared to a matched, historical control group (The Inter99 study and the Copenhagen and Odense alcohol rehabilitation cohorts). Liver-related outcomes are defined as liver-related death, liver transplant, progression to liver-related complications (ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, jaundice, bleeding from esophagastric varices, hepatocellular carcinoma) or MELD-Na score \>15
Biopsy-verified advanced fibrosis
时间窗: 5 years
Number of patients with biopsy-verified, advanced fibrosis (Kleiner fibrosis score ≥F3) detected by screening
次要结局
- Mortality(10 years)
- Liver related outcomes(10 years)
研究者
Maja Thiele
Associate professor
Odense University Hospital