title: More advanced hepatic fibrosis in hispanics with chronic hepatitis C infection: role of patient demographics, hepatic necroinflammation, and steatosis.
abstract: OBJECTIVE
  We sought to assess whether Hispanics have more advanced hepatitis C virus (HCV)-related liver disease than non-Hispanic whites (NHW) and to identify contributory factors.
  
  
  METHODS
  Patients were recruited from the Los Angeles county hepatitis clinic. Liver fibrosis and necroinflammation (NI) were assessed by the Ishak scoring system. Hepatic steatosis was graded as 0-4.
  
  
  RESULTS
  A total of 232 patients were evaluated, 63 NHW and 169 Hispanic. Hispanics were older and had a higher prevalence of blood transfusion (40%vs 21%), obesity (body mass index > 30) (47%vs 21%), diabetes mellitus (DM) (16%vs 5%), and hepatic steatosis (79%vs 47%), p < 0.02. Independent predictors of hepatic steatosis were Hispanic ethnicity (odds ratio [OR] 3.8, 95% CI 1.7-8.7, p= 0.001) and obesity (OR 5.7, 95% CI 2.3-14.1, p= 0.0002). Compared with NHW, Hispanics also had higher fibrosis stage (3.3 +/- 2 vs 2.3 +/- 6.9, p= 0.001), NI grade (6.4 +/- 1.8 vs 5.6 +/- 1.6, p= 0.002), and faster fibrosis progression/yr (0.14 +/- 0.09 vs 0.09 +/- 0.07, p= 0.0002). Presence of DM (OR 2.9, p= 0.02), grade 1-2 hepatic steatosis (OR 2.3, p= 0.03), AST/ALT > 1 (OR 4.3, p= 0.01), NI grade (OR 1.7, p < 0.0001), age at biopsy (OR 1.1, p < 0.0001), and serum bilirubin (OR 5.4, p < 0.0001) were independent predictors of fibrosis stage > or =4.
  
  
  CONCLUSIONS
  This study confirms that Hispanics have more advanced hepatic fibrosis than NHW. This is related to older age, higher NI grade, and greater prevalence of hepatic steatosis and DM.
authors.affiliation: Division of Gastrointestinal and Liver Diseases, Hepatitis Research and Treatment Center, Los Angeles, California, USA.
authors.forename: Sumita
authors.initials: S
authors.lastname: Verma
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bonacini
authors.forename: Sugantha
authors.initials: S
authors.lastname: Govindarajan
authors.forename: Gary
authors.initials: G
authors.lastname: Kanel
authors.forename: Karen L
authors.initials: KL
authors.lastname: Lindsay
authors.forename: Allan
authors.initials: A
authors.lastname: Redeker
mesh_terms: D016009:Chi-Square Distribution; D003710:Demography; D005234:Fatty Liver / Q000208:ethnology / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000208:ethnology / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000208:ethnology* / Q000473:pathology; D006630:Hispanic or Latino; D006801:Humans; D007249:Inflammation / Q000208:ethnology / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000208:ethnology / Q000473:pathology; D012307:Risk Factors; D016019:Survival Analysis