Chronic Hepatitis C Patients with Metabolic Syndrome Are at Greater Risk of Death

By Liz Highleyman

Obesity, insulin resistance, and abnormal blood lipid levels increase the risk of death for people with chronic hepatitis C virus (HCV) infection, according to a study presented at the 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009) last month in Copenhagen.

A growing body of evidence indicates that the metabolic syndrome -- a collection of manifestations including high body mass index (BMI), altered glucose and fat metabolism, and hypertension (high blood pressure) -- is interrelated with conditions including cardiovascular disease, HIV disease, and liver disease, including chronic hepatitis C. Among hepatitis C patients, obesity and diabetes have been linked to both accelerated fibrosis progression and poorer response to interferon-based therapy.

Zobair Younossi and colleagues from Inova Health System analyzed the relationship between metabolic syndrome and hepatitis C outcomes using data from the Third National Health and Nutrition Examination Survey (NHANES III, conducted 1988-1994) and associated Linked Mortality Files containing follow-up information on causes of death through 2000.

A total of 264 people with hepatitis C (HCV RNA positive) were compared to about 13,000 people without liver disease. Individuals with liver disease or risk factors unrelated to HCV -- such as hepatitis B, heavy alcohol use, and non-alcoholic fatty liver disease -- were excluded. People with hepatitis C were much more likely to smoke tobacco than those in the control group (64% vs 27%).

Results

Hepatitis C patients were significantly more likely than control subjects to have insulin resistance, defined as HOMA score > 3 (37% vs 23%; P < 0.0001).

The hepatitis C group also a higher rate of diabetes mellitus than the control group (9% vs 6%; P = 0.0885).

Conversely, people with hepatitis C had slightly lower rates of hypertension and obesity.

In comparison with HCV negative individuals, the HCV positive group had:

Higher overall mortality (adjusted hazard ration [AHR] 2.80);

Higher liver-related mortality (AHR 17.96);

Higher diabetes-related mortality (AHR 18.55);

Higher mortality related to solid organ malignancies (AHR 1.60).

Among the hepatitis C patients, the top 3 predictors of liver-related mortality were higher BMI, insulin resistance, and elevated serum cholesterol.

In a multivariate analysis, increased overall or all-cause mortality in the hepatitis C group was associated with components of the metabolic syndrome:

Type 2 diabetes: AHR 2.14;

Hypertension: AHR 1.41;

Higher BMI: AHR 1.05.

Increased liver-related mortality in this group was significantly associated with 2 of the same factors:

Hypertension: AHR 3.751;

Higher BMI: AHR 1.275.

Based on these findings, the researchers concluded, "Components of metabolic syndrome are associated with overall and liver-related mortality in HCV infected patients."

Due to lack of retrospective data, this study did not include biopsy findings to identify the extent of liver damage, nor information on HCV genotype, which is known to play a role in liver steatosis (fat accumulation in liver cells), which itself is increasingly recognized as a component of the metabolic syndrome.

Center for Liver Diseases and Center for Integrated Research, Inova Fairfax Hospital, Inova Health System, Falls Church, VA.

5/08/09

Reference
N Rafiq, M Stepanova, B Lam, and Z Younossi. Type 2 diabetes (DM), obesity and hypertension (HTN) are associated with mortality in hepatitis C (HCV) patients. 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009). Copenhagen, Denmark. April 22-26, 2009.

EASL 2009 MAIN PAGE

15th Conference on Retroviruses and Opportunistic Infections (CROI 2009)
Coverage by HIV and Hepatitis.com - February 8 - 11, 2009, Montreal
HIV and AIDS Treatment News, Experimental News, FDA-approved News

Highlights of the 15th Conference on Retroviruses and Opportunistic Infections (CROI 2009) - Coverage by HIV and Hepatitis.com, February 8 - 11, 2009, Montreal