Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection

Abstract

Background and aims: Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the factors related to steatosis and IR in CHB patients, compared with CHC subjects, and to evaluate the potential association between these features and fibrosis severity. Material and methods: One hundred and seventy consecutive patients with CHB (28 HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and metabolic measurements and matched for sex, age and body mass index with 170 genotype 1 CHC patients. IR was defined if HOMA-IR 4 2.7. All biopsies were scored for grading and staging by Scheuer's score, and the steatosis was considered significant if Z10%. Results: The prevalence of significant steatosis was similar in both CHB and CHC patients (31 vs. 38%; P = 0.14). IR rate was significantly higher in CHC than in CHB patients (42 vs. 26%; P = 0.002). Severe fibrosis (F3-F4), at multivariate analysis, was independently associated with older age (OR 1.050, 95% CI 1.009-1.093), steatosis 4 10% (OR 4.375, 95% CI 1.749-10.943), and moderate-severe necroinflammatory activity (OR 8.187,), regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95% CI 1.028-1.136), IR (OR 2.640, 95% CI 1.110-6.281), steatosis 4 10% (OR 3.375, 95% CI 1.394-8.171), and moderate-severe necroinflammatory activity (OR 8.988,) in CHC patients. Conclusions: CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate.

Hepatic Steatosis: Prevalence and Host/Viral Risk Factors in Iranian Patients with Chronic Hepatitis B Infection

“…Likewise, in other reports, no significant association was found between the stage of fibrosis and the severity of steatosis (Bondini et al, 2007;Peng et al, 2008;Rastogi et al, 2011). However, by univariate analysis, when the cut off of >3 was used as criterion decision for severe fibrosis, a strong relationship between fibrosis and HS was achieved (p=0.026), a finding similar to two reports (Shi et al, 2008;Petta et al, 2011). Moreover, on multivariate analysis when we compared the HIA scores with the stages of fibrosis in both groups of patients, higher stages of fibrosis (>3) were associated with HAI scores of necroinflammation (P value<0.001), consistent with other reports of patients with CHC and CHB (Altlparmak et al, 2005;Peng et al, 2008).…”

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…168 Coexistent hepatic steatosis is common in chronic hepatitis C (HCV) infection and is strongly associated with more advanced liver disease. [169][170][171] Another large study showed high prevalence of steatosis (40.5%) and steatohepatitis (15%) in patients with primary biliary cirrhosis (PBC), 172 although at least some of the steatosis and steatohepatitis in that study was suspected to be due to alcohol consumption. In clinical practice, it is not uncommon for obese and/or diabetic patients with autoimmune liver disease to exhibit steatosis and steatohepatitis in their liver biopsies.…”

Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis

“…Traditional diagnosis and grading of steatosis requires liver biopsy, with the key distinction between mild and moderate disease generally corresponding to 30-33% fat content at histopathology [13][14][15]. Greater degrees of steatosis have been shown to correlate with worse outcomes in the setting of liver resection, transplantation, and hepatitis C and B virus [14,16,17]. However, although the presence and severity of nonalcoholic steatohepatitis (NASH) and, in particular, the degree of fibrosis portend a worse prognosis in NAFLD [18,19], the natural history of incidental hepatic steatosis, including its actual risk of progression to fibrosis/ cirrhosis and the risk of cardiovascular events, is not well established.…”