Diabetes Linked To Liver Fibrosis Severity In Patients With HCV

Francisco J. Pasquel, MD, MPH

New findings from a recent study of treatment-naive patients with chronic hepatitis C virus (HCV) infection, specifically those with a high prevalence of obesity, diabetes, and alcohol use in underserved populations, showed an independent relationship between diabetes and liver fibrosis severity.

Moreover, data show alcohol use was associated with worse fibrosis in the patient population, but no interaction was noted between diabetes and alcohol use.

“Our findings suggest an urgent need to investigate the interaction of multiple risk factors and the progression of liver disease to help inform evidence-based liver cancer screening strategies for individuals at highest risk,” wrote study author Francisco J. Pasquel, MD, MPH, Division of Endocrinology, Department of Medicine, Emory University School of Medicine.

The retrospective, cross-sectional analysis included treatment-naive adults with HCV at the Grady Memorial Hospital Liver Clinic in Atlanta, Georgia who had index ultrasound elastography performed between January 2018 - December 2019. Data within approximately 12 months of ultrasound elastography was collected from electronic health records (EHRs).

In order to compare continuous variables, investigators conducted F tests or nonparametric tests for variables and x2 tests for categorical variables. Data were stratified by diabetes and obesity.

Outcomes of interest for the study included fibrosis severity (F0/F1 to F4 stage) and steatosis severity (S0 to S3 stage). Investigators additionally explored effect modification, investigating whether the association of diabetes with fibrosis and steatosis had differences due to alcohol use.

A total of 965 patients who underwent ultrasound elastography were identified, although 5 were excluded due to mission data. The final sample included 960 patients with a mean age of 58.3 years.

Data show 632 (65.8%) patients were men, 761 (79.3%) were Black, 247 (25.7%) had obesity. 231 (24.0%) had diabetes, and 260 (27.1%) had a history of alcohol use.

Pasquel and colleagues observed overall fibrosis scores as such:

• 501 patients (52.2%) had F0 to F1 (no scarring to mild scarring)
• 212 patients (22.1%) had F2 (moderate scarring)
• 80 patients (8.3%) had F3 (severe scarring)
• 167 patients (17.4%) had F4 (advanced scarring)

Then, they observed the steatosis scores as follows:

• 622 patients (64.8%) had S0 (none)
• 117 patients (12.2%) had S1 (mild)
• 111 patients (11.6%) had S2 (moderate)
• 110 patients (11.5%) had S3 (severe)

When compared to patients without obesity or diabetes, investigators saw patients with obesity or a combination of obesity and diabetes had higher rates of S3 steatosis (5.7% versus 22.4% versus 34.1%; P <.001).

Further, diabetes had noted independent associations with advanced fibrosis (odds ratio [OR], 1.76; 95% CI, 1.29 - 2.39) and steatosis (OR, 1.44; 95% CI, 1.04 - 2.02) in the fully adjusted model.

In addition, alcohol use was independently associated with fibrosis (OR, 1.43; 95% CI, 1.08 - 1.89) and steatosis (OR, 1.40; 95% CI, 1.03 - 1.90). Obesity status was associated with both fibrosis (OR, 1.36; 95% CI, 1.02 - 1.80) and steatosis (OR, 4.78; 95% CI, 3.52 - 6.50).

However, no significant interactions between diabetes status and alcohol use with fibrosis (P = .24) and steatosis (P = .99) severity outcomes were observed.

The study, “Association of Obesity, Diabetes, and Alcohol Use With Liver Fibrosis Among US Adults With Hepatitis C Virus Infection,” was published in JAMA Network Open.