Janczura J, Brzdęk M, Flisiak R, Dobrowolska K, Brzdęk K, Rzymski P, Zarębska-Michaluk D. Steatotic liver disease in patients with chronic hepatitis C. World J Hepatol 2025; 17(12): 113639 [DOI: 10.4254/wjh.v17.i12.113639]
Corresponding Author of This Article
Michał Brzdęk, Collegium Medicum, Jan Kochanowski University, aleja IX Wieków Kielc 19A, Kielce 25-516, Poland. michal.brzdek@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Dec 27, 2025; 17(12): 113639 Published online Dec 27, 2025. doi: 10.4254/wjh.v17.i12.113639
Steatotic liver disease in patients with chronic hepatitis C
Jakub Janczura, Michał Brzdęk, Robert Flisiak, Krystyna Dobrowolska, Kinga Brzdęk, Piotr Rzymski, Dorota Zarębska-Michaluk
Jakub Janczura, Michał Brzdęk, Krystyna Dobrowolska, Collegium Medicum, Jan Kochanowski University, Kielce 25-516, Poland
Michał Brzdęk, Department of Gastroenterology, Medical University of Lodz, Lodz 92-213, Poland
Robert Flisiak, Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok 15-540, Poland
Kinga Brzdęk, Department of Rheumatology and Connective Tissue Diseases, Nicolaus Copernicus Memorial Hospital in Lodz, Lodz 93-513, Poland
Piotr Rzymski, Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań 60-806, Poland
Dorota Zarębska-Michaluk, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Kielce 25-516, Poland
Author contributions: Janczura J, Flisiak R, and Zarębska-Michaluk D conceived the study design; Janczura J, Dobrowolska K, and Zarębska-Michaluk D acquired the final version of the manuscript; Brzdęk M and Brzdęk K prepared tables and figures; Brzdęk M performed the statistical analysis, prepared manuscript for the submission; all authors contributed to analyzed and interpreted the data, drafted the manuscript, and approved the final version of the manuscript.
Institutional review board statement: This observational, single-center study was conducted following the approval of the Bioethics Committee of Jan Kochanowski University in Kielce (approval No. 57/2024, dated July 25, 2024).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement:
Dataset available upon reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michał Brzdęk, Collegium Medicum, Jan Kochanowski University, aleja IX Wieków Kielc 19A, Kielce 25-516, Poland. michal.brzdek@gmail.com
Received: August 31, 2025 Revised: September 9, 2025 Accepted: November 20, 2025 Published online: December 27, 2025 Processing time: 118 Days and 2.8 Hours
Abstract
BACKGROUND
Steatotic liver disease (SLD) including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepatitis C (CHC).
AIM
To compare the characteristics of patients with CHC virus infection and the treatment with direct-acting antivirals (DAAs), considering the presence of SLD comorbidity.
METHODS
The study included all consecutive hepatitis C virus-infected patients treated with pangenotypic DAA regimens at a single tertiary hepatology center in 2018-2024. SLD was diagnosed via abdominal ultrasound.
RESULTS
Among 688 patients included in the study, 290 (42.2%) had comorbid SLD. The highest prevalence (62.3%) was observed in patients infected with genotype 3. The SLD group was predominantly male (62.8%), in contrast to the non-SLD group, where women predominated. Patients with SLD were significantly older (P = 0.0007), had a higher body mass index (P < 0.0001), and more frequently presented with diabetes (P = 0.01), obesity (P < 0.0001), hyperlipidemia (P = 0.004), and a history of alcohol abuse (P < 0.0001). They also had more advanced liver disease as indicated by a higher rate of cirrhosis (35.5% vs 12% in the non-SLD group, P < 0.0001), elevated aminotransferase activity (P < 0.0001), bilirubin concentration (P < 0.0001), and international normalized ratio values (P = 0.0001), and lower albumin concentration (P = 0.0028). While most patients in both groups completed treatment as planned, adverse events, including severe events and deaths, were more frequent in the SLD group. A sustained virologic response was achieved in 97.6% of the overall population but was significantly lower among patients with SLD compared to the non-SLD group (95.6% vs 99.0%, P = 0.0081). However, logistic regression analysis did not identify SLD as an independent predictor of treatment failure.
CONCLUSION
Comorbid SLD was common among CHC patients treated with DAAs and was associated with adverse baseline characteristics, including older age, higher body mass index, greater comorbidity burden, and more advanced liver disease. Although SLD patients achieved slightly lower rates of sustained virologic response, SLD itself was not an independent predictor of treatment failure. These findings suggest that poorer treatment outcomes in this subgroup are largely attributable to coexisting risk factors rather than SLD per se, highlighting the need for comprehensive management of metabolic and liver-related comorbidities to optimize antiviral therapy outcomes.
Core Tip: Steatotic liver disease (SLD) is common in patients with chronic hepatitis C and shapes their overall health and treatment journey. In our real-world study, SLD patients were older, had higher body mass index, and carried more metabolic and liver-related risks, leading to lower response rates to antiviral therapy. Yet, SLD itself was not the culprit - other comorbidities were. This highlights that successful treatment depends not only on antivirals but also on managing the broader metabolic and lifestyle factors that impact liver health.
