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abstract 179. INFLUENCE OF STEATOSIS ON CHRONIC HEPATITIS C OUTCOME:
PROSPECTIVE STUDY OF 164 PATIENTS WITH CIRRHOSIS
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Nathalie Ganne-Carrie, Hosp Jean Verdier, Bondy France; Sylvie Chevret, Hosp
Saint-Louis, Paris France; Catherine Guettier, Marianne Ziol, Christos
Christidis, Jean-Claude Trinchet, Michel Beaugrand, Hosp Jean Verdier, Bondy
France
editorial note: Steatosis can be defined as the accumulation of fat globules
within the cells of the liver resulting in deterioration of tissue and
diminshed functioning of the liver. In HIV/HCV coinfection fat can increase
in the blood for patients taking HIV therapy. Steatosis in coinfected
patients may be associated with the accelerated HCV progression seen in
HIV-infected patients. More research is needed on this subject. As well, a
recent study presented at Retrovirus 2001 showed that HCV/HIV coinfected
patients may be more likely to have lipodystrophy than patients with only
HIV.
Steatosis is a frequent feature of HCV chronic hepatitis and may contribute
to hepatocyte apoptosis and liver fibrogenesis. The aim of this study was to
assess the influence of macrovesicular steatosis in the outcome of
HCV-related cirrhosis without HBV or HIV co-infection. Patients and Methods:
all consecutive patients hospitalized in our unit for compensated HCV-related
cirrhosis (Child-Pugh A) from 1990 to 1995 and who were then prospectively
followed for hepatocellular carcinoma (HCC) screnning until death or june
2000 were enrolled. Liver steatosis was scored and its predictive value for
death and the occurrence of HCC was assessed by Kaplan-Meier method, Log-Rank
test and Cox model.
Results: 164 patients were enrolled (91 men, mean age 64). Forty-three of
them had daily alcohol consumption > 40 g, 36 had mellitus diabetes and 62
had BMI > 25 Kg/m2. Mediane and mean values of hepatocyte steatosis were 5
and 11% (0-80); 71 had < 5% steatosis and 93 > or equal to 5% (including 22
with steatosis > or equal to 30%). At the reference date, (mean follow-up:
109 months), 41 have developed HCC and 78 have died (including 16 with HCC).
The Cox model selected 3 predictive parameters for death : age (p=0.04, RR
1.8), prothrombin time (p=0.04, RR 2.2) and steatosis > or equal to 30%
(p=0.04, RR 2.3), and 4 predictive parameters for the occurrence of HCC :
steatosis < 5% (p=0.05, RR 3.3), age > or equal to 50 years (p=0.03, RR 9.3),
male sex (p=0.04, RR 2.3) and presence of esophageal varices (p=0.003, RR
3.3).
Conclusions: in HCV-related cirrhosis, macrovesicular steatosis is predictive
for death and is inversely correlated with the occurrence of HCC. These
results could suggest a pro-apoptotic role of steatosis.
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