Relationship between serum ferritin, hepatic iron staining, diabetes mellitus and fibrosis progression in patients with chronic hepatitis C

Background: Chronic infection with the hepatitis C virus affects over 170 million individuals worldwide and 20% of patients develop cirrhosis after 20 years. Increased iron stores and hepatic iron content have been suggested to be important in fibrosis progression. The increased prevalence of diabetes mellitus has been associated with increased iron deposits in patients with chronic hepatitis C. Aim: To assess the potential relationship between serum ferritin and hepatic iron staining and liver fibrosis in patients with chronic hepatitis C virus infection and whether these factors are increased in diabetic patients with hepatitis C virus. Methods: This was a cross-sectional, multi-centre study involving hospitals in the north-east of London between 1992 and 2003. Chronic hepatitis C patients with a liver biopsy and data concerning age, sex, basal metabolic index, diabetes mellitus or impaired glucose tolerance, alcohol intake, serum ferritin level and ethnicity were enrolled. Each biopsy was scored for fibrosis and stained for hepatic iron. Results: Three hundred and thirty nine patients (200 Caucasian; 139 Asian) were enrolled. Fifty three patients had no fibrosis, 131 had mild fibrosis (stage one to two Modified Ishak), 68 moderate fibrosis (stage three to four) and 87 cirrhosis (stage five to six). 4.4% of patients had elevations in serum ferritin, whilst 11% had increased hepatic iron staining. The serum ferritin and hepatic iron staining were unrelated to the degree of fibrosis. Serum ferritin was significantly higher in patients with diabetes or impaired glucose tolerance compared to non-diabetics. No association was seen between diabetes and hepatic iron staining. Conclusions: Many patients with chronic hepatitis C virus infection may have elevated serum ferritin and/or iron deposition within the liver. However, both played no significant role in the progression of hepatitis C virus related liver injury. The association between chronic hepatitis C virus infection and type II diabetes mellitus exists, however the biological mechanism of this association still remains to be elucidated.