City-Hospital Collaboration for Early Detection of Liver Fibrosis in Primary Care: A Secondary Prevention Project in the Grenoble Health Area

Overview

Cirrhosis and hepatocellular carcinoma (HCC) are responsible for 25,000 deaths per year in France. The main causes are excessive alcohol consumption, metabolic steatosis, and hepatitis B and C. Fibrosis, classified from F0 (absence of fibrosis) to F4 (cirrhosis), is the sole determinant of liver-related mortality, particularly from stage F3. The incidence of metabolic steatosis is increasing, associated with a rise in mortality from chronic liver diseases (CLD). CLDs, often asymptomatic, are diagnosed late, reducing patient survival. Recommendations exist for the screening of hepatic fibrosis in at-risk patients (alcohol, diabetes, metabolic syndrome). This screening relies on calculating the FIB-4 score (calculated from widely prescribed variables: AST, ALT, platelets, age), followed by Fibroscan® (a non-invasive test for hepatic fibrosis) if FIB-4 \> 1.3. A Fibroscan® result \<8kPa excludes advanced fibrosis, while a result \>9.6kPa suggests advanced fibrosis and ≥15kPa indicates cirrhosis. The appropriate care pathway includes a risk reduction program, a specialized consultation for patients with Fibroscan® ≥8kPa, and semi-annual screening for HCC in the case of cirrhosis. Indeed, it has been shown in a French cohort of patients with viral C cirrhosis that adherence to semi-annual screening is associated with better survival. Eligible patients are primarily seen in primary care, and INCA has published a recommendation intended for general practitioners to improve the screening of fibrosis \[13\]. However, FIB-4 is poorly known among general practitioners \[14\], and access to Fibroscan® remains limited \[15\], hindering the implementation of the recommendations. Therefore, a care pathway has been established in the Grenoble area, initiated by Professor Costentin, allowing access to Fibroscan® for patients in primary care, starting from 2022 at the CHU. The objective is to evaluate the completion of the pathway, particularly the management of MCF risk factors and referral to specialized consultation for patients with Fibroscan® ≥8 kPa.

Interventions

• Other Non-interventional study (RIPH category 3)
  The study aims to describe and evaluate an existing care pathway, implemented within the framework of current clinical practice, without modifying the modalities of care or adding specific interventions. No additional procedures are imposed on participants, apart from data collection for evaluation purposes and telephone interviews.

Primary outcome measures

• Evaluation of managment of risk factors for significant liver fibrosis. [Time frame: Up to 30 months]

Secondary outcome measures (6)

• Frequency of risk factors for liver fibrosis. [Time frame: Up to 30 months]
• Evaluation of managment of risk factors for liver fibrosis. [Time frame: Up to 30 months]
• Evaluation of patients satisfaction after [Time frame: Up to 30 months]
• Evaluation of social determinals of health associated to the risks of advanced of liver fibrosis. [Time frame: up to 30 months]
• Evaluation of managment of risk factors for significant liver fibrosis in chu Grenoble Alpes patients . [Time frame: up to 30 months]
• Evaluation of the proportion of patients who had at least one specialized consultation within 12 months. [Time frame: up to 30 months]

Eligibility criteria

Inclusion criteria

• Patients aged 18 years or older
• Having undergone a Fibroscan® at the CHU de Grenoble-Alpes or CPTS-SEG, requested by a primary care practitioner (general practitioner, non-hospital diabetologist, Asalée nurse), as part of the screening recommendations for liver fibrosis in the case of a FIB4 score > 1.3
• With a result ≥ 8kPa
• Between January 2023 and January 2026

Exclusion criteria

• Patients who have expressed their opposition to participating in the study
• Patients under guardianship or deprived of liberty
• Patients with a known chronic liver disease who are being monitored at the time of the Fibroscan® procedure

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Study design

Observational model

Cohort

Study locations

France · 2 centers

• Communauté Professionnelle Territoriale de Santé Sud Est Grenoblois — Grenoble
• Grenoble Alpes University Hospital — Grenoble

Identifiers

NCT: NCT07031089 · 2025-A010187-42

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗