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Observational Study
. 2017 Jan;96(3):e5832.
doi: 10.1097/MD.0000000000005832.

Liver steatosis in children with chronic hepatitis B and C: Prevalence, predictors, and impact on disease progression

Maria Pokorska-Śpiewak  1 , Barbara Kowalik-Mikołajewska, Małgorzata Aniszewska, Magdalena Pluta, Bożena Walewska-Zielecka, Magdalena Marczyńska
Affiliations
Observational Study

Liver steatosis in children with chronic hepatitis B and C: Prevalence, predictors, and impact on disease progression

Maria Pokorska-Śpiewak et al. Medicine (Baltimore). 2017 Jan.

Abstract

Only scarce data on liver steatosis in children with chronic hepatitis B and C (CHB and CHC) are available. The objective of this study was to evaluate the prevalence, predictors, and impact of hepatic steatosis on children with CHB and CHC. A total of 78 patients aged 11.5 ± 3.4 years were included: 30 (38%) had CHB, and 48 (62%) had CHC. Steatosis was scored on a 5-point scale, as follows: absent; minimal (≤5% hepatocytes affected), mild (6-33%), moderate (34-66%), and severe (>66%). Stepwise logistic regression was used to determine the factors associated with steatosis and moderate-to-severe steatosis. Steatosis was observed in 4/30 (13%) patients with CHB and 13/48 (27%) patients with CHC (P = 0.17). Moderate-to-severe steatosis was observed in 6/78 (8%) patients: 1/30 (3%) had CHB and 5/48 (10%) had CHC (P = 0.40). The body mass index (BMI) z-score was positively associated with the presence of steatosis in children with CHB (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.02-10.64). In CHC, steatosis occurred more frequently in patients with hepatitis C virus genotype 3 compared with other genotypes (P = 0.002). In patients with non-3 genotype hepatitis C virus, steatosis was associated with the stage of fibrosis (OR = 3.35, 95% CI: 1.01-11.07) and inversely associated with the duration of infection (OR = 0.74, 95% CI: 0.55-0.97). Moderate-to-severe steatosis was positively associated with the BMI z-score (OR = 3.62, 95% CI: 1.22-10.75) and stage of fibrosis (OR = 3.89, 95% CI: 1.05-14.47). Steatosis is a common finding in children with chronic viral hepatitis. It is associated with metabolic factors in CHB, whereas in patients with CHC, metabolic and viral factors may have a combined effect, leading to more advanced grades of steatosis in children with higher BMI z-scores. Moderate-to-severe steatosis is a predictor of advanced fibrosis in children with CHC.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Prevalence of different grades of liver steatosis in the whole study group, in children with chronic hepatitis B and chronic hepatitis C. Minimal steatosis indicates ≤5% of hepatocytes affected; mild: 6–33%, moderate: 34–66%, and severe: >66%.
Figure 2
Figure 2
Box-and-whiskers plot for body mass index z-score in children with and without steatosis. The top and bottom of each box are the 25th and 75th percentiles. The line through the box is the median and the error bars are the maximum and minimum. CHB = chronic hepatitis B, CHC = chronic hepatitis C.
Figure 3
Figure 3
Box-and-whiskers plot for body mass index z-score in children with moderate-to-severe steatosis. The top and bottom of each box are the 25th and 75th percentiles. The line through the box is the median and the error bars are the maximum and minimum. CHC = chronic hepatitis C.
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