Disease severity and erythropoiesis in chronic hepatitis C

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The erythropoiesis in hepatitis C virus infection is unclear. We aimed to evaluate the erythropoietic components in chronic hepatitis C (CHC) patients.


The red blood cell (RBC) components, serum erythropoietin (EPO) levels, and their relationship to clinical characteristics were evaluated between 124 age-matched and sex-matched healthy controls and 248 histology-proven CHC patients.


Chronic hepatitis C patients had significantly higher serum levels of EPO (1.44 ± 0.36 log mIU/mL versus 1.03 ± 0.31 log mIU/mL, P < 0.0001) and lower hemoglobin (Hb) concentrations (14.6 ± 1.4 g/dL versus 15.3 ± 1.2 g/dL, P < 0.001) as compared with healthy controls. Among the CHC patients, the serum EPO level was negatively associated with the Hb concentration (β = −0.227; 95% confidence intervals [CI]: −0.09–0.027; P < 0.001) and RBC counts (β = −0.204; 95% CI: −0.245–0.061; P = 0.001) and was positively correlated with necroinflammatory activity (β = 0.201; 95% CI: 0.009–0.046; P = 0.003) and fibrosis (β = 0.143; 95% CI: 0.003–0.076; P = 0.04) of liver histopathology. For non-cirrhotic CHC patients, the severity of liver necroinflammatory activity was positively correlated with the reticulocyte and serum EPO levels (P = 0.001 and 0.008, respectively), and negatively related to the RBC counts (P = 0.03). Using stepwise multivariate linear regression analysis, the grade of necroinflammatory activity was positive (β = 0.214; 95% CI: 0.046–0.209, P = 0.002), whereas the Hb concentration was inversely (β = −0.205; 95% CI: −0.09–0.018, P = 0.004) associated with the serum EPO levels in CHC patients.


The disease activity in CHC patients had a negative impact on erythropoiesis with compensatory higher but blunted EPO responses.

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