title: Cryoglobulinemia and progression of fibrosis in chronic HCV infection: cause or effect?
abstract: OBJECTIVE
  Mixed cryoglobulinemia (MC) is the most common extrahepatic manifestation of HCV infection. The aim of this study is to determine the prevalence of MC in HCV infected Greek patients and to identify if it is associated with liver histology or the mode of HCV transmission.
  
  
  METHODS
  One hundred and twenty-six patients with chronic HCV infection were evaluated for the presence of serum cryoglobulins, autoantibodies and viral markers. One hundred and eighteen of them underwent liver biopsy and each specimen was evaluated according to the grading and staging system described by Ishak et al.
  
  
  RESULTS
  Cryoglobulins were detected in 37/126 (29.4%) HCV patients and cryocrit values ranged between 0.5 and 6.5%. Only two patients presented clear clinical manifestations of MC. In patients with MC, a higher grading (6.40+/-2.06 vs. 5.27+/-2.55, p=0.013) and staging score (3.71+/-1.45 vs. 2.83+/-1.84, p=0.007) was noted in liver biopsy compared to those without MC. Logistic regression analysis identified staging score (OR, 1.33; CI, 1.06-1.66, p=0.015) as the only independent variable associated with cryoglobulinemia. Correlation between the presence of cryoglobulins and the mode of HCV transmission was not found.
  
  
  CONCLUSIONS
  Greek patients with chronic HCV infection have high prevalence of cryoglobulinemia. A clear association between the presence of serum cryoglobulins and staging score of chronic hepatitis was found, with no difference in patients' age or the duration of infection. It is possible that cryoglobulinemia results in more rapid hepatic fibrosis in HCV infected patients.
authors.affiliation: Department of Internal Medicine, Patras University Hospital, Patras, Greece. dsiagris@mland.gr
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siagris
authors.forename: Myrto
authors.initials: M
authors.lastname: Christofidou
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsamandas
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lekkou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Thomopoulos
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Labropoulou-Karatza
mesh_terms: D001323:Autoantibodies / Q000302:isolation & purification; D003449:Cryoglobulinemia / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005355:Fibrosis / Q000150:complications* / Q000473:pathology; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012217:Rheumatoid Factor / Q000097:blood
chemical_list: D001323:Autoantibodies; D012217:Rheumatoid Factor