Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data.
OBJECTIVE
Steatosis is a frequent histologic finding in chronic hepatitis C (CHC), but it is unclear whether steatosis is an independent predictor for liver fibrosis. We evaluated the association between steatosis and fibrosis and their common correlates in persons with CHC and in subgroup analyses according to hepatitis C virus (HCV) genotype and body mass index.


METHODS
We conducted a meta-analysis on individual data from 3068 patients with histologically confirmed CHC recruited from 10 clinical centers in Italy, Switzerland, France, Australia, and the United States.


RESULTS
Steatosis was present in 1561 patients (50.9%) and fibrosis in 2688 (87.6%). HCV genotype was 1 in 1694 cases (55.2%), 2 in 563 (18.4%), 3 in 669 (21.8%), and 4 in 142 (4.6%). By stepwise logistic regression, steatosis was associated independently with genotype 3, the presence of fibrosis, diabetes, hepatic inflammation, ongoing alcohol abuse, higher body mass index, and older age. Fibrosis was associated independently with inflammatory activity, steatosis, male sex, and older age, whereas HCV genotype 2 was associated with reduced fibrosis. In the subgroup analyses, the association between steatosis and fibrosis invariably was dependent on a simultaneous association between steatosis and hepatic inflammation.


CONCLUSIONS
In this large and geographically different group of CHC patients, steatosis is confirmed as significantly and independently associated with fibrosis in CHC. Hepatic inflammation may mediate fibrogenesis in patients with liver steatosis. Control of metabolic factors (such as overweight, via lifestyle adjustments) appears important in the management of CHC.
Leandro
Gioacchino
G
IRCSS de Bellis, Castellana Grotte, Italy.
Mangia
Alessandra
A
Hui
Jason
J
Fabris
Paolo
P
Rubbia-Brandt
Laura
L
Colloredo
Guido
G
Adinolfi
Luigi E
LE
Asselah
Tarik
T
Jonsson
Julie R
JR
Smedile
Antonina
A
Terrault
Norah
N
Pazienza
Valerio
V
Giordani
Maria Teresa
MT
Giostra
Emiliano
E
Sonzogni
Aurelio
A
Ruggiero
Giuseppe
G
Marcellin
Patrick
P
Powell
Elizabeth E
EE
George
Jacob
J
Negro
Francesco
F
D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000453:epidemiology / Q000473:pathology; D008019:Life Style; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology