Clinical predictors of fibrosis in patients with chronic liver disease

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http://www3.interscience.wiley.com/journal/123291715/abstract

Alimentary Pharmacology & Therapeutics

Volume 31 Issue 10, Pages 1085 - 1094

Published Online: 18 Feb 2010

Journal compilation © 2010 Blackwell Publishing Ltd

Clinical predictors of fibrosis in patients with chronic liver disease

M. STEPANOVA*,†, R. AQUINO*, A. ALSHEDDI*, R. GUPTA†, Y. FANG† & Z.

YOUNOSSI*,†

*Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA, USA ;

†Betty and Guy Beatty Center for Integrated Research, Inova Health System,

Falls Church, VA, USA

Correspondence to Dr Z. Younossi, Betty and Guy Beatty Center for Integrated

Research at Inova Health System, 3300 Gallows Road, Falls Church, VA 22042, USA.

E-mail: zobair.younossi@...

Copyright Journal compilation © 2010 Blackwell Publishing Ltd

Aliment Pharmacol Ther 31, 1085–1094

ABSTRACT

Background

Patients with chronic liver disease and components of metabolic syndrome may be

at higher risk for fibrosis.

Aim

To assess the impact of clinicodemographic factors on hepatic fibrosis in CLD.

Methods

Of 1028 chronic liver disease patients, 964 were included in the analysis.

Extensive clinico-demographic and histological data were available. Significant

baseline fibrosis (METAVIR stage ≥2) and fibrosis progression (increase of

≥1 stage in subsequent biopsy) were compared between groups using univariate

and multivariate analyses.

Results

Compared with HCV and HBV, NAFLD patients were more obese (higher BMI and waist

circumference), diabetic, hypertensive and hyperlipidaemic. Significant fibrosis

occurred in 55%, 43% and 20% of HCV, HBV and NAFLD, respectively. Factors

independently associated with fibrosis in NAFLD included DM, elevated AST and

ALT. For viral hepatitis, independent predictors of fibrosis were low platelet

count (HBV and HCV), age (HBV) and elevated AST and ALT (HCV). A second biopsy

was available for 96 patients with follow-up of about 4 years. Factors

independently associated with progression of fibrosis were HCV infection, higher

ALT and lower platelet count.

Conclusions

Diabetes mellitus is an independent risk factor for fibrosis only in NAFLD.

Elevated aminotransferases and/or low platelet counts are independently

associated with significant baseline fibrosis or progression of fibrosis, in

patients with chronic liver disease.

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Publication data Submitted 12 January 2010 First decision 25 January 2010

Resubmitted 29 January 2010 Accepted 10 February 2010 Epub Accepted Article 18

February 2010

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2036.2010.04266