Association between Hepatic Steatosis and Fibrosis in Chronic Viral Hepatitis B and C Patients

Background: Chronic viral hepatitis B (CHB) and chronic viral hepatitis C (CHC) are important causes of chronic liver disease and cancer development in patients with progressive fibrosis, which are often associated with hepatic steatosis. Objective: To evaluate the prevalence of hepatic steatosis in Thai CHB and CHC patients and its correlation with fibrosis stage. Materials and Methods: The authors examined the liver biopsy findings of CHB and CHC patients diagnosed at Srinagarind Hospital between 2016 and 2018. Routine Hematoxylin and Eosin staining with PAS, and Masson trichrome staining were used to evaluate fibrosis and steatosis histology according to the METAVIR and SAF scoring systems. The association were evaluated by chi-square, Fisher’s exact, and Spearman’s correlation tests with statistical significance defined as p-value less than 0.05. Results: One hundred thirty-eight cases were examined. The mean age of the patients was 45 years. Chronic hepatitis C was detected in 96 patients (69.6%), and CHB was detected in 42 patients (30.4%). Liver biopsies showed steatosis in 73 patients (52.9%; grade 1: 67.1%, grade 2: 19.2%, and grade 3: 13.7%). Steatosis was associated with viral hepatitis profile (OR 2.534, 95% CI 1.087 to 5.904, p=0.031); however, the METAVIR fibrosis stage associated with the age of the patient (OR 1.059, 95% CI 1.012 to 1.109, p=0.014) and METAVIR activity (OR 4.924, 95% CI 2.443 to 9.967, p<0.0001). Conclusion: Hepatic steatosis is commonly present in Thai CHC and CHB patients, and especially in the former. Steatosis was associated with viral hepatitis profile. Hepatic fibrosis is associated only with the age of the patient and METAVIR activity. Keywords: Chronic hepatitis B, Chronic hepatitis C, Steatosis, Fibrosis, METAVIR, SAF score, Liver biopsy