title: Liver steatosis in children with chronic hepatitis B and C: Prevalence, predictors, and impact on disease progression.
abstract: Only scarce data on liver steatosis in children with chronic hepatitis B and C (CHB and CHC) are available. The objective of this study was to evaluate the prevalence, predictors, and impact of hepatic steatosis on children with CHB and CHC. A total of 78 patients aged 11.5 ± 3.4 years were included: 30 (38%) had CHB, and 48 (62%) had CHC. Steatosis was scored on a 5-point scale, as follows: absent; minimal (≤5% hepatocytes affected), mild (6-33%), moderate (34-66%), and severe (>66%). Stepwise logistic regression was used to determine the factors associated with steatosis and moderate-to-severe steatosis. Steatosis was observed in 4/30 (13%) patients with CHB and 13/48 (27%) patients with CHC (P = 0.17). Moderate-to-severe steatosis was observed in 6/78 (8%) patients: 1/30 (3%) had CHB and 5/48 (10%) had CHC (P = 0.40). The body mass index (BMI) z-score was positively associated with the presence of steatosis in children with CHB (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.02-10.64). In CHC, steatosis occurred more frequently in patients with hepatitis C virus genotype 3 compared with other genotypes (P = 0.002). In patients with non-3 genotype hepatitis C virus, steatosis was associated with the stage of fibrosis (OR = 3.35, 95% CI: 1.01-11.07) and inversely associated with the duration of infection (OR = 0.74, 95% CI: 0.55-0.97). Moderate-to-severe steatosis was positively associated with the BMI z-score (OR = 3.62, 95% CI: 1.22-10.75) and stage of fibrosis (OR = 3.89, 95% CI: 1.05-14.47). Steatosis is a common finding in children with chronic viral hepatitis. It is associated with metabolic factors in CHB, whereas in patients with CHC, metabolic and viral factors may have a combined effect, leading to more advanced grades of steatosis in children with higher BMI z-scores. Moderate-to-severe steatosis is a predictor of advanced fibrosis in children with CHC.
authors.affiliation: Department of Children's Infectious Diseases, Medical University of Warsaw Hospital of Infectious Diseases in Warsaw Department of Public Health, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Pokorska-Śpiewak
authors.forename: Barbara
authors.initials: B
authors.lastname: Kowalik-Mikołajewska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Aniszewska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pluta
authors.forename: Bożena
authors.initials: B
authors.lastname: Walewska-Zielecka
authors.forename: Magdalena
authors.initials: M
authors.lastname: Marczyńska
mesh_terms: D000293:Adolescent; D002648:Child; D018450:Disease Progression; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies