Clinical predictors of fibrosis in patients with chronic liver disease

Patients with chronic liver disease and components of metabolic syndrome may be at higher risk for fibrosis.

To assess the impact of clinicodemographic factors on hepatic fibrosis in CLD.

Of 1028 chronic liver disease patients, 964 were included in the analysis. Extensive clinico-demographic and histological data were available. Significant baseline fibrosis (METAVIR stage > or =2) and fibrosis progression (increase of > or =1 stage in subsequent biopsy) were compared between groups using univariate and multivariate analyses.

Compared with HCV and HBV, NAFLD patients were more obese (higher BMI and waist circumference), diabetic, hypertensive and hyperlipidaemic. Significant fibrosis occurred in 55%, 43% and 20% of HCV, HBV and NAFLD, respectively. Factors independently associated with fibrosis in NAFLD included DM, elevated AST and ALT. For viral hepatitis, independent predictors of fibrosis were low platelet count (HBV and HCV), age (HBV) and elevated AST and ALT (HCV). A second biopsy was available for 96 patients with follow-up of about 4 years. Factors independently associated with progression of fibrosis were HCV infection, higher ALT and lower platelet count.

Diabetes mellitus is an independent risk factor for fibrosis only in NAFLD. Elevated aminotransferases and/or low platelet counts are independently associated with significant baseline fibrosis or progression of fibrosis, in patients with chronic liver disease.