Chronic hepatitis C virus infection: Prevalence of extrahepatic manifestations and association with cryoglobulinemia in Bulgarian patients

Table 1 Prevalence of clinical and biological extrahepatic manifestations in 136 patients with chronic HCV infection

Clinical manifestations	n (%)
Fatigue	81 (59.6)
Renal involvement	34 (25.0)
Type 2 diabetes mellitus	31 (22.8)
Paresthesia	27 (19.9)
Arthralgia	25 (18.4)
Purpura	24 (17.6)
Pulmonary fibrosis	21 (15.4)
Thyroid dysfunction	20 (14.7)
Raynaud's phenomenon	16 (11.8)
B-cell lymphoma	12 (8.8)
Sicca-syndrome (xerostomia)	9 (6.6)
Lichen planus	8 (5.9)
Biological manifestations
Cryoglobulinemia	51 (37.5)
Thrombocytopenia	4 (31.6)
ANA	25 (18.4)
АSMА	23 (16.9)
АNCA	18 (13.2)
Аnticardiolipin antibodies	12 (8.8)
Overall
At least 1 extrahepatic manifestation	104 (76.5)

ANA: Anti-nuclear antibodies; АSMА: Anti-smooth muscle antibodies; АNCA: Anti-neutrophil cytoplasm antibodies.

Table 2 Relationship between cryoglobulin-positivity and the presence (%) of extrahepatic manifestations in patients with chronic HCV infection

Extrahepaticmanifestations	Cryoglobulin-positivepatients (n = 51)	Cryoglobulin-negativepatients (n = 85)	P	Odds ratio(95% confidence interval)
Fatigue	92.2	40.0	0.000	17.6 (5.8-53.4)
Purpura	41.2	3.5	0.000	19.1 (5.3-68.8)
Raynaud' phenomenon	25.5	3.5	0.000	9.3 (2.5-34.7)
Arthralgia	33.3	9.4	0.001	4.8 (1.8-12.2)
Paresthesia	41.2	7.1	0.000	9.2 (3.3-25.0)
Renal involvement	45.1	12.4	0.000	5.5 (2.3-12.7)
Type 2 diabetes	35.3	15.3	0.011	3.0 (1.3-6.8)
Lymphadenomegaly	35.3	4.7	0.000	11.0 (3.4-35.1)
Lymphoma	17.6	3.5	0.015	5.8 (1.5-22.7)
Pulmonary fibrosis	25.5	9.4	0.015	3.2 (1.2-8.6)
Thyroid dysfunction	15.7	14.1
Xerostomia	11.8	3.5
Lichen planus	7.8	4.7
Thrombocytopenia	58.8	15.3	0.000	7.9 (3.5-17.8)
ANA	29.4	11.8	0.013	3.1 (1.2-76.0)
ASMA	33.3	7.1	0.000	6.5 (2.3-18.1)
ANCA	25.5	5.9	0.002	5.4 (1.9-16.4)
ACL-antibodies	17.6	3.5	0.010	5.8 (1.5-22.7)

ANA: Anti-nuclear antibodies; АSMА: Anti-smooth muscle antibodies; АNCA: Anti-neutrophil cytoplasm antibodies; ACL: Anti-cardiolipin.

Table 3 Univariate and multivariate logistic regression analysis of factors associated with the presence of extrahepatic manifestations in patients with chronic HCV infection

Factors	Patients with the factor (%) inthe presence of extrahepaticmanifestations (n = 104)	Patients with the factor (%) inthe absence of extrahepaticmanifestations (n = 32)	Uni-variateanalysis	Multi-variateanalysis	Odds ratio(95% confidence interval)
Female sex	59.6	37.5	0.042
Age ≥ 60 yr	43.3	3.1	0.000
Duration of infection ≥ 20 yr	66.3	3.1	0.000	0.001	36.3 (4.6-284.9)
Transfusion of blood and blood products	43.3	15.6	0.006
Metavir A3	30.8	15.6
Metavir F4	52.9	3.1	0.000	0.011	15.4 (1.8-125.9)
Alcohol ≥ 50 g/d	24.0	28.1