The impact of hepatic steatosis on the natural history of chronic hepatitis C infection

J Viral Hepat. 2009 Jul;16(7):492-9. doi: 10.1111/j.1365-2893.2009.01098.x. Epub 2009 Feb 5.

Abstract

Since patients with hepatitis C virus (HCV) often have hepatic steatosis, this retrospective analysis aimed to assess whether steatosis influences fibrosis progression. We studied 112 HCV RNA positive subjects (median age 44, IQR 39-51 years), who had two liver biopsies performed (median biopsy interval 50, 34-74 months). Fibrosis was staged using the Ishak method and steatosis by the Kleiner system (<5% steatosis = S0, 5-33% = S1, 33-66% = S2, and >66% = S3). The subjects were untreated because they had mild fibrosis (n = 59), declined therapy (n = 48), or had co-existing disease precluding treatment (n = 5). On first liver biopsy, 60 (54%) had S0, 34 (30%) had S1, 12 (11%) had S2, and 6 (5%) had S3. Steatosis was associated with genotype 3, odds ratio 4.8 (95% CI 1.3-16.7, P = 0.02). Twenty-three patients (21%) had disease progression on the second biopsy, defined as an increase in Ishak score by > or =1 stage. On univariate analysis, fibrosis progression was associated with older age (P = 0.004), higher AST (P = 0.04), and steatosis (P = 0.005) but on multivariate analysis, only baseline steatosis was significant, odds ratio 14.3 (2.1-111.1, P = 0.006). Kaplan-Meier analysis demonstrated that steatosis impacted on time to progression to both significant fibrosis (Ishak > or =F3) and cirrhosis (Ishak F5-6) (P = 0.001 and P = 0.049, respectively). The finding that steatosis was significantly associated with fibrosis progression indicates that, independent of baseline fibrosis stage, patients should be considered for anti-viral treatment if steatosis is present. Furthermore, strategies to reduce steatosis may have a beneficial effect on fibrosis progression and, therefore, patient outcome.

MeSH terms

  • Adult
  • Biopsy
  • Disease Progression
  • Fatty Liver / complications*
  • Fatty Liver / pathology
  • Female
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / pathology
  • Humans
  • Kaplan-Meier Estimate
  • Liver / pathology
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / pathology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors