Centrilobular Fibrosis Is Not a Specific Feature of Steatohepatitis in the Setting of Chronic Hepatitis C Infection
JF Coleman, R Lopez, A Pillai, IA Hanouneh, NN Zein. Cleveland Clinic, Cleveland, OH
Background: Coexistent steatohepatitis (SH) can occur in patients infected with hepatitis C virus (HCV), but study of these patients is complicated by the fact that HCV can cause metabolic derangements including hepatic steatosis. Although steatosis and lobular inflammation are nonspecific findings, the presence of hepatocellular ballooning degeneration and centrilobular fibrosis (CLF) have been proposed as markers of SH in the setting of HCV. We hypothesize that CLF is not specific, however, and may be seen in HCV without superimposed SH.
Design: Patients with HCV and two liver biopsies between 1997 and 2006 were identified with the electronic medical record. Biopsies were scored by two pathologists for necroinflammation (modified HAI), fibrosis (Ishak, stages 0-6), steatosis (%), and CLF (0 absent, 1 mild, 2 marked). Patients with combined hepatocellular ballooning degeneration, steatosis, and CLF at baseline were excluded for a possible diagnosis of SH. Patients were also excluded for insufficient biopsy tissue (< 10 portal tracts) and incomplete clinical data. Patients were divided into groups of those with (56) and without (15) CLF at baseline. Age and BMI were compared with student's t-tests, histology scores with Wilcoxon rank sum tests and categorical factors (sex, race, ethanol, tobacco, diabetes mellitus, antiviral therapy and sustained virologic response) with Fisher's Exact tests. Fibrosis progression-free rates were compared with a Kaplan-Meier plot and log-rank test.
Results: CLF was seen in 56 of 71 patients (79%) at baseline. These subjects had higher inflammation and modified staging scores than those without CLF (P<0.05). There were no other significant differences between the groups, including BMI, history of diabetes mellitus, alcohol abuse, and subsequent development of SH. In addition, the rate of fibrosis progression was not significantly different between patients with and without CLF at baseline.
Conclusions: CLF is found in HCV patients without other findings of SH and does not correlate with BMI, history of diabetes mellitus, or alcohol use. The presence of CLF does not predict more rapid progression of fibrosis or subsequent development of steatohepatitis.
Category: Liver & Pancreas
Monday, March 22, 2010 1:15 PM
Platform Session: Section D, Monday Afternoon