Factors Influencing the Rate of Fibrosis Progression in Chronic Hepatitis C

Abstract

Alcohol consumption, age at infection, and male gender have been identified as risk factors for faster fibrosis progression in patients with chronic hepatitis C (CHC). Yet the influence of liver steatosis, light to moderate alcohol consumption, or iron overload on this progression remains controversial. To analyze the effect of individual risk factors and their interaction on fibrosis progression in a group of patients with CHC and a definite date of infection, we studied 133 consecutive untreated patients. Covariates included were age, body mass index (BMI), gender, age at infection, alcohol intake, serum lipids, glycemia, serum ALT, AST, GGT, iron, and ferritin, grade and stage (METAVIR and Scheuer), and hepatic stainable iron (Perl's stain). The rate of fibrosis progression was inferred from the METAVIR score. By logistic regression analysis, hepatic steatosis (odds ratio [OR], 3.035; 95% confidence interval [CI], 1.16-7.93), serum ferritin levels higher than 290 ng/ml (OR, 5.5; 1.6-18.65), and light to moderate ethanol intake (1-50 g/day) (OR, 5.22; 1.5-17.67) were independently associated with faster fibrosis progression. There was no effect of interaction between these variables on the rate of fibrosis progression. Liver steatosis, serum ferritin levels, and light to moderate alcohol intake are associated with faster fibrosis progression in chronic hepatitis C. Combination of these factors did not further accelerate this progression. The impact of modification of these factors on progression should be tested in longitudinal studies.

Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

“…6,8,10,12,13,14,17,19 Although the difference was not significant, we found higher BMI values in patients with severe fibrosis compared to those with mild fibrosis.…”

“…7,8,[10][11][12]14,15,18 Our study showed that elevated serum GGT levels and prolonged prothrombin time were independent variables predicting the severity of liver fibrosis. While chronic liver disease progress to cirrhosis, decreased albumin level and thrombocyte count, and increased bilirubin level are expected findings.…”

“…[4][5][6]9,11,12,[17][18][19]21,23 The contentious conclusions might be due to following three reasons: 1) Studies are either crosssectional or longitudinal and involve repeated liver biopsies: In cross-sectional studies that evaluate a single liver biopsy, the duration of fatty infiltration is unknown. Therefore, longitudinal studies are more powerful.…”

“…8,12,13,16,17,[28][29][30] This discrepancy has been attributed to the intermittent viremia in patients with chronic HCV infection. The lack of relationship between HCV RNA levels and liver fibrosis in our study may be due to a single HCV RNA value.…”

“…Results on the effect of gender on fibrosis in chronic HCV infection are controversial. 3,4,[6][7][8][9][10][11][12][16][17][18][19][20][21][22][23] Two studies suggest that male gender has a worsening effect on fibrosis progression. 16,17 Some authors attributed the higher prevalence of severe liver fibrosis in male patients with chronic HCV infection to the inhibitory effect of estrogen on stellate cell proliferation and fibrosis in women.…”