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Hepatitis C, cryoglobulinemia, and cirrhosis: a meta-analysis
Zeid Kayali1, Victor E Buckwold, Bridget Zimmerman
1Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
Insights
Patients with chronic hepatitis C virus (HCV) infection and cryoprecipitates (CP) have a significantly higher risk of developing cirrhosis. Cryoglobulins may serve as a prognostic indicator for progressive liver disease in HCV patients.
Area of Science:
- Hepatology
- Immunology
- Virology
Background:
- Chronic hepatitis C virus (HCV) infection is linked to extrahepatic complications of cryoglobulinemia.
- The relationship between cryoglobulinemia and liver disease progression, specifically cirrhosis, remains unclear.
Purpose of the Study:
- To investigate the association between cryoprecipitates (CP) and cirrhosis in patients with chronic HCV.
- To determine if CP is an independent risk factor for progressive liver disease or a confounding variable.
Main Methods:
- A meta-analysis of 19 studies (1994-2001) involving 2,323 chronic hepatitis C patients.
- Logistic regression analysis adjusted for age, gender, and estimated duration of disease (EDD).
Main Results:
- 44% of HCV patients had detectable CP.
- Cirrhosis incidence was 40% in patients with CP versus 17% without CP.
- Adjusted odds ratio for cirrhosis in CP-positive vs. CP-negative patients was 4.87 (95% CI: 3.32, 7.15), indicating a strong association.
Conclusions:
- Cryoprecipitates are significantly associated with cirrhosis in chronic hepatitis C.
- Cryoglobulins may act as a prognostic indicator for increased risk of cirrhosis in HCV patients.
Abstract:
Approximately 40% of patients with chronic hepatitis C virus (HCV) infection develop detectable serum cryoglobulins or cryoprecipitates (CP), although most do not show clinical or physical signs of syndromic cryoglobulinemia. Although association of HCV with the extrahepatic complications of cryoglobulinemia is widely recognized, the relationship of cryoglobulinemia with liver disease is unclear. We wished to study the relationship between CP and cirrhosis and to determine whether the development of CP is a true covariate for progressive liver disease or a confounding variable that impacts cirrhosis because of patient age, duration of disease, or differences in gender. We undertook a meta-analysis of 19 studies published between 1994 and 2001. The incidence of cirrhosis was compared in patients with and without CP after logistic regression adjustments for accepted risk factors for progressive liver disease, including age, gender, and estimated duration of disease (EDD). A total of 2,323 patients with chronic hepatitis C were identified, with 1,022 (44%) having detectable CP. Cirrhosis was present in 40% of patients with CP but only 17% of patients without CP (total Chi;(2) = 141.69, P <.001). After adjusting for age, gender, and estimated duration of disease by logistic regression, the combined odds ratio for incidence of cirrhosis in patients CP positive versus CP negative was 4.87, (95% CI: 3.32, 7.15), indicating a highly significant association between cirrhosis and cryoglobulinemia. In conclusion, cryoglobulins may be a useful prognostic indicator for increased risk of cirrhosis with chronic hepatitis C.