Prevalence and Predictive Factors of Liver Steatosis Evaluated by CAP in Chronic Viral Hepatitis Infected Patients

Y. Essadni *

EFD-HGE Unit, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco.

M. Salihoun

EFD-HGE Unit, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco.

I. Serraj

EFD-HGE Unit, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco.

M. Acharki

EFD-HGE Unit, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco.

N. Kabbaj

EFD-HGE Unit, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Introduction: The CAP (Controlled Attenuation Parameter) function of FibroScan® is a new non-invasive diagnostic tool that allows the quantification of liver steatosis at the same time as elastometry. It is based on the attenuation of ultrasound waves. Its use is particularly validated in chronic viral hepatitis.

Objectives: evaluate the frequency and the predictive factors of liver steatosis diagnosed by CAP in a cohort of patients with chronic viral hepatitis submitted to transient elastography by Fibroscan ®.

Methods: This was a retrospective single center study conducted from May 2019 to May 2023. Were included all patients with chronic viral hepatitis B or C who had transient elastography performed with CAP by Fibroscan ®.

Results : Among 636 patients who had a Fibroscan ®, 305 had chronic viral hepatitis: 204 (32%) HVB and 131 (20,5%) HVC.

Mean age was 55±9 years and 55,2% of patients were female. 30% of our patients were obese and 33.5% were overweight. 20,1% of our patients had diabetes, 25,8% had hypertension and 9,3% had dyslipidemia.

The mean CAP value (±SD) was 230,5 dB/m with a corresponding mean liver elasticity of 9.1 kPA. Liver steatosis was found in 38,8% of our patients.

49% of patients with chronic hepatitis C had steatosis on Fibroscan, 32% of those with chronic hepatitis B.

CAP values were significantly correlated with body mass index (p < 0.001), dyslipidemia (p < 0.010) and the presence of steatosis on ultrasound (p < 0.012). In contrast, there was no correlation between CAP values and age, sex, or the existence of diabetes or hypertension.

Conclusion: Fibroscan CAP function detected liver steatosis in 38,8% of patient with viral hepatitis, which was strongly associated with host metabolic factors, e.g., obesity and dyslipidemia. These cofactors may contribute to the progression of liver disease. Thus, they require serious management concomitantly with antiviral therapy.

Keywords: Viral hepatitis, liver steatosis, controlled attenuation parameter


How to Cite

Essadni, Y., Salihoun , M., Serraj , I., Acharki , M., & Kabbaj , N. (2024). Prevalence and Predictive Factors of Liver Steatosis Evaluated by CAP in Chronic Viral Hepatitis Infected Patients. Asian Journal of Research and Reports in Gastroenterology, 7(1), 81–86. Retrieved from https://journalajrrga.com/index.php/AJRRGA/article/view/134

Downloads

Download data is not yet available.

References

Cardoso AC, Perez RM, de Figueiredo-Mendes C, Carvalho Leite N, Moraes-Coelho HS, Villela-Nogueira CA. Prevalence and predictive factors of moderate/severe liver steatosis in chronic hepatitis C (CHC) infected patients evaluated with controlled attenuation parameter (CAP). Journal of Viral Hepatitis; 2018. DOI: 10.1111/jvh.12930

Bedossa P. Pathology of non -alcoholic fatty liver disease. Liver Int. 2017 Jan;37 Suppl 1:85 - 89. DOI: 10.1111/liv.13301

Sirinawasatien A, Techasirioangkun T. The prevalence and determinants of hepatic steatosis assessed by controlled attenuation parameter in thai chronic hepatitis C patients. Gastroenterol Res pract. 2020 Nov 2;2020:8814135. DOI: 10.1155/2020/8814135 PMID: 33204256 PMCID: PMC7655258

Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–1321. DOI: 10.1002/hep.20701

Sheikh MY, Choi J, Qadri I, Friedman JE, Sanyal AJ. Hepatitis C virus infection: Molecular pathways to metabolic syndrome. Hepatology. 2008;47(6):2127–2133. DOI: 10.1002/hep.22269

Wong SW, Chan WK. Epidemiology of non-alcoholic fatty liver disease in Asia. Indian Journal of Gastroenterology. 2020;39(1):1–8. DOI: 10.1007/s12664-020-01018-x

Sasso M, Tengher -Barna I, Ziol M, Miette V, Fournier C, Sandrin L, Poupon R, Cardoso AC, Marcellin P, Douvin C, de Ledinghen V, Trinchet JC, Beaugrand M. Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan®: Validation in chronic hepatitis C. J Viral Hepat. 2012 Apr;19(4):244 -53. DOI: 10.1111/j.1365 - 2893.2011.01534.x. Epub 2011 Oct 13

Ferraioli G, Tinelli C, Lissandrin R, Zicchetti M, Dal Bello B, Filice G, Filice C. Controlled attenuation parameter for evaluating liver steatosis in chronic viral hepatitis. World J Gastroenterol. 2014 Jun 7;20(21):6626-31. DOI: 10.3748/wjg.v20.i21.6626. PMID: 24914387 PMCID: PMC4047351

Boursier J, Zarski JP, de Ledinghen V, Rousselet MC, Sturm N, Lebail B, Fouchard-Hubert I, Gallois Y, Oberti F, Bertrais S, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57:1182–1191.

Khov N, Sharma A, Riley TR. Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease. World J Gastroenterol. 2014 Jun 14;20(22):6821 -5. DOI: 10.3748/wjg.v20.i22.6821

Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, Clark JM. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta -analysis. Hepatology. 2011 Sep 2;54(3):1082 -1090. DOI: 10.1002/hep.24452

Sasso M, Tengher-Barna I, Ziol M, Miette V, Fournier C, Sandrin L, Poupon R, Cardoso AC, Marcellin P, Douvin C, et al. Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan(®): Validation in chronic hepatitis C. J Viral Hepat. 2012;19:244–253

Zheng RD, Chen JN, Zhuang QY, Lu YH, Chen J, Chen BF. Clinical and virological characteristics of chronic hepatitis B patients with hepatic steatosis. Int J Med Sci. 2013;10(5):641-6. DOI: 10.7150/ijms.5649. Epub 2013 Mar 25 PMID: 23569427 PMCID: PMC3619103

Shi YW, Yang RX, Fan JG. Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion. World J Gastroenterol. 2021 Jul 14;27(26):3971-3983. DOI: 10.3748/wjg.v27.i26.3971 PMID: 34326608 PMCID: PMC8311534

Hwang SJ, Luo JC, Chu CW, Lai CR, Lu CL, Tsay SH, et al. Hepatic steatosis in chronic hepatitis C virus infection: Prevalence and clinical correlation. J Gastroenterol Hepatol. 2001;16:190e195

Thomopoulos KC, Arvaniti V, Tsamantas AC, Dimitropoulou D, Gogos CA, Siagris D, et al. Prevalence of liver steatosis in patients with chronic hepatitis B: a study of associated factors and of relationship with fibrosis. Eur J Gastroenterol Hepatol. 2006;18:233e237.

Patton HM, Patel K, Behling C, et al. The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients. Journal of Hepatology. 2004;40(3):484–490. DOI: 10.1016/j.jhep.2003.11.004

Machado MV, Oliveira AG, Cortez-Pinto H. Hepatic steatosis in hepatitis b virus infected patients - meta-analysis of risk factors and comparison with hepatitis c infected patients. Journal of Gastroenterology and Hepatology, no–no; 2011. DOI: 10.1111/j.1440-1746.2011.06801.x

Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease: A clinical histopathological study. Am. J. Gastroenterol. 2003; 98: 2042–7.

Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterology. 2007;132(6):2169–2180. DOI: 10.1053/j.gastro.2007.03.059

Adinolfi LE, Gambardella M, Andreana A, Tripodi MF, Utili R, Ruggiero G. Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity. Hepatology. 2001;33(6): 1358–1364. DOI: 10.1053/jhep.2001.24432

Singhai A, Yadav V, Joshi R, Malik R, T SB, Kamle S. Prevalence, metabolic profile, and associated risk factors of non-alcoholic fatty liver disease in an adult population of India. Cureus. 2023 Jan 19;15(1):e33977. DOI: 10.7759/cureus.33977 PMID: 36820120 PMCID: PMC9938792

Younossi Z, Park H, Henry L, Adeyemi A, Stepanova M. Extrahepatic manifestations of hepatitis C: A meta-analysis of prevalence, quality of life, and economic burden. Gastroenterology. 2016;150(7):1599–1608. DOI: 10.1053/j.gastro.2016.02.039

Büsch K, Waldenström J, Lagging M, et al. Prevalence and comorbidities of chronic hepatitis C: A nationwide population-based register study in Sweden. Scandinavian Journal of Gastroenterology. 2017;52(1):61–68. DOI: 10.1080/00365521.2016.1228119

Seto WK, Hui RWH, Mak LY, Fung J, Cheung KS, Liu KSH, et al. Association between hepatic steatosis, measured by controlled attenuation parameter, and fibrosis burden in chronic hepatitis B. Clinical gastroenterology and hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association. 2018;16:575-583 e572.

Mak LY, Wan-Hin Hui R, Fung J, Liu F, Ka-Ho Wong D, Cheung KS, Yuen MF, Seto WK, Diverse effects of hepatic steatosis on fibrosis progression and functional cure in virologically quiescent chronic hepatitis B, Journal of Hepatology; 2020. DOI:https://doi.org/10.1016/ j.jhep.2020.05.040

Tsai PS, Cheng YM, Wang CC, Kao JH. The impact of concomitant hepatitis C virus infection on liver and cardiovascular risks in patients with metabolic-associated fatty liver disease. Eur J Gastroenterol Hepatol. 2023 Nov 1;35(11): 1278-1283. DOI: 10.1097/MEG.0000000000002558. Epub 2023 Sep 27 PMID: 37773778

Shi YW, Yang RX, Fan JG. Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion. World J Gastroenterol. 2021 Jul 14;27(26):3971-3983.

DOI: 10.3748/wjg.v27.i26.3971 PMID: 34326608 PMCID: PMC8311534

Kumar M, Rastogi A, Singh T, Behari C, Gupta E, Garg H, Kumar R, Bhatia V, Sarin SK. Controlled attenuation parameter for non -invasive assessment of hepatic steatosis: Does etiology affect performance? J Gastroenterol Hepatol. 2013 Jul;28(7):1194 -201. DOI: 10.1111/jgh.12134