title: Histological versus clinical cirrhosis in chronic hepatitis C: does race/ethnicity really matter?
abstract: Liver fibrosis progression in hepatitis C virus (HCV) infection has been in part associated with race/ethnicity. Little is known of the frequency of clinical cirrhosis in Asian patients in the US.
  
  
  OBJECTIVE
  To compare histological and clinical features of chronic hepatitis C (CHC) in a multiethnic cohort of patients.
  
  
  METHODS
  Retrospective query of an electronic medical registry for CHC patients evaluated from 1999 to 2005. Histological cirrhosis was defined as advanced METAVIR fibrosis score at biopsy. Clinical cirrhosis was defined as any of: varices, ascites, or splenomegaly. Liver cirrhosis was defined as either histological or clinical cirrhosis. Chi-square tests, t tests, and logistic regression method were used for data analysis.
  
  
  RESULTS
  Six hundred and ninety-two patients were categorized into four racial-ethnic groups: 292 Caucasian (C), 145 Hispanic (H), 121 African American (AA), and 134 Asian (As) patients. Median age of AA (54 years) and As (53) was higher than C (52), or H (50) (p < 0.05). H patients had a higher percentage of alcohol abuse (60%) than AA and C (42-44%) and As (14%; p < 0.0001). Body mass index (BMI) was significantly lower in Asians compared to all other groups (p < 0.0001). Features of the metabolic syndrome were common, ranging from 28% in As to 72% in H patients. Liver cirrhosis was found in 53% H, 35% C, 29% As, and 19% AA. In multivariable analysis, only alcohol abuse, BMI, diabetes mellitus (DM), and age were significantly associated with liver cirrhosis. There was a trend for AA to have less cirrhosis, either histological or clinical (p = 0.08).
  
  
  CONCLUSIONS
  Using only histology, liver cirrhosis was significantly underestimated. In our cohort, severity of CHC was not clearly affected by race when alcohol use and features of the metabolic syndrome were taken into consideration. However, there was a trend for African Americans to have lower cirrhosis rates.
authors.affiliation: Department of Transplantation, California Pacific Medical Center, 2340 Clay Street, Suite 308, San Francisco, CA 94115, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kohla
authors.forename: Shunpei
authors.initials: S
authors.lastname: Iwata
authors.forename: Roth
authors.initials: R
authors.lastname: Ea
authors.forename: Sanaz
authors.initials: S
authors.lastname: Keyhan
authors.forename: Robert
authors.initials: R
authors.lastname: Taylor
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Yu
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bonacini
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data*; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000208:ethnology* / Q000473:pathology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000208:ethnology* / Q000473:pathology*; D008113:Liver Neoplasms / Q000208:ethnology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult