Cirrhosis, Fibrosis, NAFLD, NASH, NASH - Nonalcoholic Steatohepatitis
Conditions
Keywords
Cohort
Brief summary
The main objective of this cohort study is to determine genetic, clinical biologic and metabolic factors associated with patient heterogeneity in regards to severity of NAFLD at diagnosis as well as during the clinical course. * at diagnosis, with the aim to better characterize patients of different severity and improve our understanding of clinical and histological heterogeneity at diagnosis * during the clinical course to better understand and predict disease progression in terms notably of fibrosis progression and progression to cirrhosis
Detailed description
Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome and is currently the most common cause of liver disease in many developed countries worldwide. The aim of the study is to improve the scientific knowledge on markers associated with disease severity and progression in NAFLD. The study is a multicentre French NAFLD cohort of well-characterized patients with biological samples covering the entire spectrum of NAFLD severity (steatosis, NASH, significant fibrosis, cirrhosis, hepatocellular carcinoma).
Interventions
OTHERBiological specimens
Biological specimens are collected to better characterize patients of different severity and improve our understanding of clinical and histological heterogeneity at diagnosis : * added for the research : blood, urine, stools * collected for the research : liver tissue sample, if a liver biopsy is indicated for clinical reasons (standard of care)
OTHERAdditional visit
Visits if possible during standard care, otherwise added by the research (If necessary the annual visit will be added by research for the collection of biological samples)
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥18 years 2. Patients with a confirmed diagnosis of NAFLD 3. Patients affiliated to French social security 4. Written informed consent signed by the patient
Exclusion criteria
1. Refusal or inability (lack of capacity) to give informed consent. 2. Average alcohol ingestion greater than 21/14 units/week (males/females) in the preceding 6 months or history of sustained excessive consumption of alcohol in past 5 years. 3. History or presence of Type 1 diabetes mellitus. 4. Presence of any other form of chronic liver disease except NAFLD 5. Recent (within 12 months) or concomitant use of agents known to cause hepatic steatosis (long-term systemic corticosteroids \[\>10 days\], amiodarone, methotrexate, tamoxifen, tetracycline, high dose oestrogens, valproic acid). 6. Any contra-indication to liver biopsy. 7. Recent (within 3 months) change in dose/regimen or introduction of Vitamin E (at a dose ≥400 IU/day), betaine, s-adenosyl methionine, ursodeoxycholic acid, silymarin or pentoxifylline. 8. Non-French speaking/unable to access an interpreter. 9. Patients judged by the investigator to be unsuitable for inclusion in the study (e.g. judged by the physician as unlikely to be compliant with the study protocol). 10. Pregnant or breastfeeding women 11. Patient under legal protection measure (tutorship or curatorship) and patient deprived of freedom
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disease severity | Change of the fibrosis stage from baseline to 10 years | The disease severity defined by the fibrosis stage on liver biopsy according to the semi-quantitative histological classification of NASH CRN. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Lobular inflammation | At baseline | Composite scores of Lobular inflammation (Ballooning and Inflammation) |
| Steatohepatitis | At baseline | Presence or Absence |
| Cirrhosis | Through study completion, an average of 10 years | Cirrhosis defined by either : 1. stage 4 of histological classification of fibrosis on liver biopsy or 2. liver stiffness \>14 kPa by elastometry |
| Obesity | Change from baseline to 10 years | Obesity defined by either : 1. Increased waist circumference by ethnically adjusted criteria or 2. BMI ≥25 |
| Type 2 diabetes | Change from baseline to 10 years | Type 2 diabetes defined by Fasting glucose ≥100 mg/dL \[5.6 mmol/L\], HbA1c ≥48mmol/mol (6.5%) or previously diagnosed insulin resistance/type 2 diabetes mellitus (or on treatment). |
| Ballooning grade | At baseline | — |
| Cardiovascular disease | Change from baseline to 10 years | Cardiovascular disease defined by arterial hypertension (systolic BP ≥130 or diastolic BP ≥85 mmHg, or on antihypertensive treatment). |
| Necroinflammation measured by the activities component of the SAF | Change from baseline to 10 years | Necroinflammation measured by the activities component of the SAF classification : ranges 0 to 4 SAF : steatosis, activity, fibrosis |
| Necroinflammation measured by the NAS score | Change from baseline to 10 years | Necroinflammation measured by the NAS score : ranges from 0 to 8 NAS score : NAFLD Activity Score |
| Fasting insulin | Change from baseline to 10 years | — |
| Insulin sensitivity | Change from baseline to 10 years | HOMA - %s |
| Dyslipidaemia | Change from baseline to 10 years | Dyslipidaemia defined by fasting TG level ≥150 mg/dL \[1.7mmol/L\]; or fasting HDL \<40 mg/dL \[1.03 mmol/L\] in males and \<50 mg/dL \[1.29 mmol/L\] in females; or on treatment); |
Contacts
Primary ContactVlad RATZIU
Outcome results
None listed