Increased serum iron and iron saturation without liver iron accumulation distinguish chronic hepatitis C from other chronic liver diseases

Abstract

One hundred twenty-three patients with chronic liver diseases of various etiologies were evaluated for their iron status. The patients were divided into four distinct groups: chronic hepatitis C (63), chronic hepatitis B (14), B + C (3) and nonviral chronic liver diseases (43). In 107 patients (87%) the chronic liver disease was confirmed by biopsy. Mean serum iron (+/- SD) levels in the above four groups were: 166 +/- 62, 103 +/- 52, 142 +/- 48, and 115 micrograms/dl; iron-binding capacity was 346 +/- 80, 325 +/- 72, 297 +/- 27, and 374 +/- 75 micrograms/dl, and iron saturation 50 +/- 18, 32 +/- 16, 48 +/- 16, and 28 +/- 10%, respectively. Serum ferritin, increased in all four groups, was highest in HCV; however, no evidence of hepatic iron accumulation could be found in any of the patients. There were no significant differences in liver function parameters measured in the four groups. We conclude that serum iron, iron saturation, and ferritin are increased in patients with hepatitis C in comparison to hepatitis B or other nonviral, nonhemochromatotic liver diseases. The increased iron status in hepatitis C patients is not manifested by increased liver iron. Awareness of these distinct features of chronic hepatitis C is essential in the diagnosis and treatment of chronic liver diseases.

Effect of iron overload on the severity of liver histologic alterations and on the response to interferon and ribavirin therapy of patients with hepatitis C infection

“…The relationship between HCV infection and serum levels of iron and ferritin was described soon after HCV was cloned. Later other investigators evaluated the association between iron levels in hepatic tissue and the severity of viral infection or the response to treatment with antiviral drugs (9,10). In our study, in which 95 samples of hepatic biopsy were analyzed, the presence of iron overload in hepatic tissue was observed in 31.6% of the cases.…”

Hyperferritinemia is a risk factor for steatosis in chronic liver disease

“…Chronic hepatitis C, with or without cirrhosis, often presents with abnormal iron indices [29,30] , particularly …”

Clinical features of hepatitis C-infected patients with persistently normal alanine transaminase levels in the southwestern United States

“…It is interesting, although not surprising, that subjects with persistently normal ALT have a significantly lower serum ferritin level because it has been reported that a high ferritin level is associated with more severe hepatitis and advanced liver disease. 23 Many HCV-positive patients with elevated aminotransferase activity have a serum ferritin level above the normal range, but only a minority of these patients have iron overload. 24 Two studies found a close relationship between serum ALT activity and ferritin level.…”