title: Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data.
abstract: 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.
authors.affiliation: IRCSS de Bellis, Castellana Grotte, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Leandro
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mangia
authors.forename: Jason
authors.initials: J
authors.lastname: Hui
authors.forename: Paolo
authors.initials: P
authors.lastname: Fabris
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Guido
authors.initials: G
authors.lastname: Colloredo
authors.forename: Luigi E
authors.initials: LE
authors.lastname: Adinolfi
authors.forename: Tarik
authors.initials: T
authors.lastname: Asselah
authors.forename: Julie R
authors.initials: JR
authors.lastname: Jonsson
authors.forename: Antonina
authors.initials: A
authors.lastname: Smedile
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.forename: Valerio
authors.initials: V
authors.lastname: Pazienza
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Giordani
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Aurelio
authors.initials: A
authors.lastname: Sonzogni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ruggiero
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Powell
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Francesco
authors.initials: F
authors.lastname: Negro
mesh_terms: 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