More advanced hepatic fibrosis in hispanics with chronic hepatitis C infection: Role of patient demographics, hepatic necroinflammation, and steatosis

BACKGROUND AND AIMS:We sought to assess whether Hispanics have more advanced hepatitis C virus (HCV)-related liver disease than non-Hispanic whites (NHW) and to identify contributory factors. PATIENTS AND METHODS: Patients were recruited from the Los Angeles county hepatitis clinic. Liver fibrosis and necroinflammation (NI) were assessed by the Ishak scoring system. Hepatic steatosis was graded as 0-4. RESULTS: A total of 232 patients were evaluated, 63 NHW and 169 Hispanic. Hispanics were older and had a higher prevalence of blood transfusion (40% vs 21%), obesity (body mass index > 30) (47% Vs 21%), diabetes mellitus (DM) (16% vs 5%), and hepatic steatosis (79% vs 47%), p < 0.02. Independent predictors of hepatic steatosis were Hispanic ethnicity (odds ratio [OR] 3.8, 95% Cl 1.7-8.7, p = 0.001) and obesity (OR 5.7, 95% Cl 2.3-14.1, p = 0.0002). Compared with NHW, Hispanics also had higher fibrosis stage (3.3 +/- 2 vs 2.3 +/- 6.9, p = 0.001), NI grade (6.4 +/- 1.8 Vs 5.6 +/- 1.6, p = 0.002), and faster fibrosis progression/yr (0.14 +/- 0.09 vs 0.09 +/- 0.07, p = 0.0002). Presence of DM (OR 2.9, p = 0.02), grade 1-2 hepatic steatosis (OR 2.3, p = 0.03), AST/ALT > I (OR 4.3, p = 0.01), NI grade (OR 1.7, p < 0.0001), age at biopsy (OR 1.1, p < 0.0001), and serum bilirubin (OR 5.4, p < 0.0001) were independent predictors of fibrosis stage > 4. CONCLUSION: This study confirms that Hispanics have more advanced hepatic fibrosis than NHW. This is related to older age, higher NI grade, and greater prevalence of hepatic steatosis and DM.