Presence Of Fibrosis In Patients Research Articles

The frequency and associated factors of pulmonary fibrosis by the twelfth month after community-acquired pneumonia

Aims: Community-acquired pneumonia (CAP) is a term used to describe an acute lung infection that develops outside of a hospital setting. Radiological sequelae may remain in a certain part of these patients that may affect their lives. We aimed to investigate the frequency of sequelae parenchymal lesions and influencing factors in patients with community-acquired pneumonia. Methods: This retrospective study included patients diagnosed with CAP. First, patients who were admitted to the chest diseases outpatient clinic for any reason and who were treated with the diagnosis of CAP in the emergency department 12 months ago at the earliest were selected. Among these patients, patients with thorax computed tomography (chest-CT) under the control of the chest diseases outpatient clinic were included in the study. Chest-CT results, demographic data and laboratory data were evaluated. Results: A total of 80 patients, 32 (40%) female and 48 (60%) male, diagnosed with CAP were included. The mean age of our patients was 56.83±13.41 (min-max: 18-71). Twenty-three (28.75%) of the patients did not have pathology in the control chest-CT, while 57 (71.25%) patients had various levels of sequelae changes. Of the sequelae observed in 57 patients, 34 (42.5%) had single linear atelectasis or single band formation or ectasia in a single bronchus, while fibrotic structure was detected in 23 (28.75%). Five (6.25%) patients had pulmonary fibrosis. Age and smoking have a statistically significant effect on the presence of fibrosis in patients with CAP. Conclusion: Mild to severe fibrotic changes were observed in one-third of our patients one year after CAP treatment. In our study, fibrotic changes were found to be highly correlated with age and smoking.

Vibration-controlled Transient Elastography in NAFLD: Review Study.

In this study, we aimed to provide information about transient elastography, a noninvasive method that shows liver steatosis and fibrosis, and to review diagnostic accuracy studies in the literature. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases. It has a wide clinical spectrum, ranging from asymptomatic steatosis to cirrhosis with complications that can lead to mortality. Although its frequency varies geographically, it is believed that one out of every four people in the world has NAFLD. Recently, the number of studies about the noninvasive diagnosis of NAFLD and liver fibrosis is increasing. Vibration-controlled transient elastography (VCTE) is a method used for about two decades and provides important information in determining steatosis and fibrosis in the liver. Area under curve (AUC) levels for ≥S1 are between 0.8 and 0.95 in studies showing the accuracy of the CAP score in detecting steatosis. Sensitivity is between 68 and 87% and specificity is 74 and 91%. AUC levels for steatosis ≥S2 range from 0.73 to 0.88. Sensitivity is between 77 and 85% and specificity is 59 and 81%. For detecting ≥S3, AUC levels were 0.69 to 0.94 and the sensitivity and specificity were 71 to 88%, and 58 to 89%, respectively. In studies, evaluating the effectiveness of elastography in determining the level of fibrosis in patients with NAFLD: AUC was between 0.79 and 0.87, sensitivity was 62 and 94%, and specificity was 61 and 100% for F ≥2. Area under curve was 0.76 to 0.98, sensitivity was 65 to 100% and specificity was 75 to 97% for ≥F3. Area under curve was ranged from 0.91 to 0.99 and sensitivity was 78 to 100% and specificity was 76 to 98% for ≥F4. The studies about the comparison of FibroScan and novel transient elastography device (FibroTouch) reported that results are correlated (r = 0.5-0.6) and the AUC of FibroTouch to detect fibrosis is nearly 0.8. AUROC in studies are mostly above 0.80 in detecting steatosis and detecting the presence of fibrosis in patients diagnosed with NAFLD indicates the reliability of the data obtained. Transient elastography is suggested by the international guidelines for diagnosing NAFLD, especially the decision of biopsy. FibroTouch was found correlated with FibroScan but further studies are necessary to indicate that FibroTouch can be used instead of FibroScan. Ozercan AM, Ozkan H. Vibration-controlled Transient Elastography in NAFLD: Review Study. Euroasian J Hepato-Gastroenterol 2022;12(Suppl 1):S41-S45.

Hepatic fibrosis as an additional risk factor for the development of cardiovascular disorders in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease

The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p<0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.

Lower eGFR is associated with increased probability of liver fibrosis in Chinese diabetic patients.

Kidney dysfunction is linked to nonalcoholic fatty liver disease (NAFLD) progression including fibrosis, steatosis, or inflammation. We aimed to explore whether lower levels of estimated glomerular filtration rate (eGFR) was associated with increased probability of liver fibrosis. Two thousand six hundred eighty-nine subjects enrolled from Shanghai, China, were included in this study. NAFLD fibrosis score (NFS) was used to risk stratify NAFLD patients for fibrosis. eGFR was used to assess kidney function. The association of eGFR level with elevated NFS, and thus high risk of fibrosis, was analysed by linear regression and multinomial logistic regression. The predictive power of eGFR was evaluated via receiver operating characteristic (ROC) curve. A negative association was found between eGFR and NFS (B = -0.21, 95% CI, -0.37 to -0.04, P = .016). As eGFR quartiles decreased, the prevalence of probable fibrosis increased after adjusting for age, sex, current smoking, waist circumference, duration of diabetes, HbA1c , hypertension, dyslipidaemia, and homeostasis model assessment index of insulin resistance (HOMA-IR) (Q4: reference; Q3: 1.49, 95% CI, 0.82-2.71; Q2: 1.88, 95% CI, 0.97-3.67; Q1: 2.70, 95% CI, 1.36-5.37, Pfor trend = .002, 1SD increment: 0.73, 95% CI, 0.58-0.92). The eGFR level can be an effective indicator in differentiating patients with probable presence of fibrosis from those without (AUROC: 0.71, cut-off point: 92.78 mL/min/1.73 m2 , P < .001). Lower levels of eGFR were associated with higher NFS and thus greater risk of presence of fibrosis in patients with NAFLD and T2DM. Individuals with NAFLD and diabetes should carefully monitor eGFR and receive regular urinalysis, especially when advanced fibrosis is suspected.

Accuracy of Noninvasive Fibrosis Scores in Predicting the Presence of Fibrosis in Patients after Liver Transplantation.

Several scoring systems have been developed to noninvasively predict the presence of advanced fibrosis in patients with chronic liver disease. Hepatitis C virus and nonalcoholic fatty liver disease are the 2 most common indications for orthotopic liver transplant and are associated with disease recurrence that can lead to fibrosis progression. Here, we evaluated the performance of commonly used fibrosis scores in assessing the presence of advanced fibrosis in patients after orthotopic liver transplant. Our study consisted of consecutive patients with hepatitis C virus or nonalcoholic fatty liver disease who underwent a liver biopsy after transplant and had laboratory measurements within 1 week of biopsy. Graft fibrosis was determined by an experienced pathologist (stage F0-F4). Advanced fibrosis was defined as stage F3-F4. The following fibrosis scores were calculated for each patient: aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase/platelet ratio index, and fibrosis-4 index. We analyzed 93 patients with median age of 59 years (25th and 75th percentile of 53 and 64 y) and median body mass index of 31.8 kg/m² (25th and 75th percentile of 27 and 37.6 kg/m²). Of total patients, 41 (44%) were diabetic. Median time to liver biopsy posttransplant was 27.7 months (25th and 75 percentile of 10.8 and 59.9 mo). We found that 54 patients (58%) had no fibrosis, 15 (16.1%) had F1, 8 (8.6%) had F2, 7 (7.5%) had F3, and 9 (9.7%) had F4. Overall, advanced fibrosis (F3-F4) was present in 16 patients. Aspartate aminotransferase/alanine amino-transferase ratio, aspartate aminotransferase/platelet ratio index, and fibrosis-4 index were not significantly different between patients with and without advanced fibrosis (all P > .05). The calculated fibrosis scores had poor diagnostic accuracy for presence of advanced fibrosis posttransplant. Commonly used liver fibrosis scores are not accurate in predicting the presence of advanced fibrosis in patients after liver transplant.

Endoscopic Ultrasound Liver Biopsies Accurately Predict the Presence of Fibrosis in Patients With Fatty liver

Endoscopic Ultrasound Liver Biopsies Accurately Predict the Presence of Fibrosis in Patients With Fatty liver

Clinical Cases: Valvular heart disease142A sub-aortic valve mass in a rheumatoid arthritis patient: an unconventional mechanism of aortic regurgitation143Symptomatic severe aortic regurgitation with coronary obstruction due to chronic type a dissection144Mitral valve prolapse and ventricular tachycardia: a long-lasting love story

Clinical Cases: Valvular heart disease142A sub-aortic valve mass in a rheumatoid arthritis patient: an unconventional mechanism of aortic regurgitation143Symptomatic severe aortic regurgitation with coronary obstruction due to chronic type a dissection144Mitral valve prolapse and ventricular tachycardia: a long-lasting love story

Thyroid Function and the Risk of Nonalcoholic Fatty Liver Disease: The Rotterdam Study.

Although thyroid function is associated with several risk factors of nonalcoholic fatty liver disease (NAFLD), its role in NAFLD development remains unclear. We aimed to prospectively investigate the association between variations in thyroid function and NAFLD. The Rotterdam Study, a large population-based, prospective cohort study. Participants with thyroid function measurements at baseline and NAFLD data (ie, at baseline fatty liver index/at follow-up ultrasound) were eligible. Transient elastography was performed to assess the presence of fibrosis in patients with NAFLD, using the liver stiffness measurements more than or equal to 8 kPa as cutoff for clinically relevant fibrosis. The association between thyroid parameters and incident NAFLD was explored by using logistic regression models. A total of 9419 participants (mean age, 64.75 y) were included. The median follow-up time was 10.04 years (interquartile range, 5.70-10.88 y). After adjusting for age, sex, cohort, follow-up time, use of hypolipidemic drugs, and cardiovascular risk factors, higher free T4 levels were associated with a decreased risk of NAFLD (odds ratio, 0.42; 95% confidence interval [CI], 0.28-0.63). In line, higher TSH levels were associated with an increased risk of having clinically relevant fibrosis in NAFLD (odds ratio, 1.49; CI, 1.04-2.15). Compared with euthyroidism, hypothyroidism was associated with a 1.24-fold higher NAFLD risk (CI, 1.01-1.53). Moreover, NAFLD risk decreased gradually from hypothyroidism to hyperthyroidism (P for trend = .003). Lower thyroid function is associated with an increased NAFLD risk. These findings may lead to new avenues regarding NAFLD prevention and treatment.

Pentraxin 3 Is a Predictor for Fibrosis and Arterial Stiffness in Patients with Nonalcoholic Fatty Liver Disease.

Objective. The aim of the present study was to investigate whether pentraxin 3 (PTX3) can be a new noninvasive marker for prediction of liver fibrosis in patients with NAFLD. We also aimed to evaluate the relationship between PTX3 and atherosclerosis in patients with NAFLD. Method. Fifty-four male patients with biopsy-proven NAFLD and 20 apparently healthy male volunteers were included. PTX3 levels were determined, using an ELISA method (R&D Sysytems, Quantikine ELISA, USA). To detect the presence of subclinical atherosclerosis in NAFLD, measurements of CIMT, FMD, and cf-PWV levels were performed. Results. PTX3 levels in NAFLD patients with fibrosis were higher than both NAFLD patients without fibrosis and controls (P = 0.032 and P = 0.028, respectively), but there was no difference between controls and NAFLD patients without fibrosis in terms of PTX3 levels (P = 0.903). PTX3 levels were strongly correlated with cf-PWV (r = 0.359, P = 0.003), whereas no significant correlation was found with other atherosclerosis markers, CIMT and FMD. Conclusion. Elevated plasma PTX3 levels are associated with the presence of fibrosis in patients with NAFLD, independently of metabolic syndrome components. This study demonstrated that for the first time there is a close association between elevated PTX3 levels and increased arterial stiffness in patients with NAFLD.

A simple clinical model to predict presence of myocardial fibrosis in patients with aortic stenosis

A simple clinical model to predict presence of myocardial fibrosis in patients with aortic stenosis

Accuracy of Noninvasive Fibrosis Scores in Predicting the Presence of Fibrosis in Patients After Liver Transplantation: Presidential Poster

Accuracy of Noninvasive Fibrosis Scores in Predicting the Presence of Fibrosis in Patients After Liver Transplantation: Presidential Poster

Su1806 Markers of Macrophage Activation and Survival Correlate With the Presence of Advanced Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Background: The prognosis of nonalcoholic fatty liver disease (NAFLD) is largely dependent on the severity of hepatic fibrosis. Macrophage and Kupffer cell activation correlates with hepatic fibrosis in chronic viral hepatitis. Apoptosis inhibitor of macrophage (AIM) supports survival of macrophages and soluble CD163 (sCD163) is a marker of macrophage activation. The aim of this study was to assess the relationship between markers of macrophage activation and survival and the presence of advanced fibrosis in adult patients with NAFLD. Methods: Patients with biopsy-proven NAFLD were enrolled in the study. Venous blood was collected from the patients on the day of the biopsy. Patients were divided into 2 groups: early stage fibrosis (F0-2) and advanced fibrosis (F3-4) based on Metavir score as assessed by an independent pathologist. Serum levels of AIM and CD 163 were measured using specific ELISAs. Comparisons between the groups were analyzed by MannWhitney U test and the data expressed as mean ± standard deviation. A p<0.05 was considered significant. Results: 40 patients were included (24 with stage 0-2 fibrosis and 16 with advanced fibrosis (F34) with a mean age of 54± 9.4 years and 32.5% were male. Patients with advanced fibrosis were more likely to have type 2 diabetes and had significantly higher AST/ALT ratio than those F0-2 (p = 0.041). More importantly, serum AIM levels were significantly higher in patients with advanced fibrosis than those with F0-2 (2042 ± 764 ng/ml and 1216± 580 ng/ml, respectively; p<0.001) with an area under the ROC curve (AUC) for predicting the presence of advanced fibrosis of 0.782 (95% CI: 0.635 -0.929). Similarly, serum sCD163 levels were significantly higher in patients with F3-4 (1722 ± 916 ng/ml) compared to those without advanced fibrosis (930 ± 433 ng/ml); p<0.001 with an AUC for predicting advanced fibrosis of 0.756 (0.589-0.922). Conclusion: Taken together, our data suggest that decreased apoptosis of macrophages leading to their increased activity as evident by high AIM and CD 163 levels plays a central role in fibrosis progression in subjects with NAFLD.

Initial evidence of presence of papillary muscle diffuse fibrosis in patients with cardiomyopathy

Background The left ventricular (LV) papillary muscles (PM) are important structure for mitral valve complex. Previous studies by echocardiography demonstrated that PM function was impaired in patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Native T1 mapping has emerged as a noninvasive magnetic resonance (MR) imaging method to assess LV diffuse myocardial fibrosis without using contrast agent. The aims of this study were to evaluate feasibility and reproducibility of PM native T1 measurement, and to compare PM T1 times between cardiomyopathy patients and controls subjects. Methods Seventeen cardiomyopathy patients (11 HCM; 6 DCM, age: 57 ± 15 years) and 16 control subjects (age: 50 ± 15 years) were enrolled. Native T1 mapping images were acquired with MOLLI (Messroghli DR et al. MRM 2004) sequence in 3 short-axis planes (basal, mid and apical slices) using an ECG-triggered single-shot acquisition with a balanced SSFP readout (TR, 3.1; TE, 1.5; FA, 35°; FOV, 360 × 337 mm; acquisition matrix, 188 × 135; voxel size, 1.9 × 2.5 mm; slice thickness, 8 mm). All data were corrected for motion (Roujol S et al. MRM 2014). Measurement of PM T1 was performed both in anterior PM and posterior PM in all subjects. Intra-observer and interobserver reproducibility was assessed by 2 readers in 20 PMs from 10 control subjects. Repeatability coefficients

Left ventricle morphological and functional characteristics associated to the presence and magnitude of myocardial fibrosis by CMR in hypertrophy cardiomiopathy

Background Hypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disease present in one in 500 of the general population, and it is main cause of sudden death in young people. The presence of myocardial fibrosis in HCM is very common (more than 2/3 of patients), and its identification by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) helps the diagnosis and it is associated with ventricular arrhythmias and worse prognosis. The aim of our study was to find CMR characteristics that are related to the presence and burden of myocardial fibrosis by CMR in HCM. Methods We evaluated 115 consecutive HCM patients who underwent cardiac MRI and analyzed both the presence/ absence of myocardial fibrosis (LGE) and also its magnitude (estimated as absolute mass of myocardial fibrosis in grams and normalized to LV mass as percentage of LV myocardial mass) with other morphological and functional factors as well as population characteristics. Patients with a history of acute myocardial infarction as well as other cardiomyopathies that could present late enhancement were excluded. Results The mean age was 46.6 ± 16.1 yo, 77% male. Eighty patients (70%) had myocardial fibrosis in cardiac MRI. Patients with myocardial fibrosis had lower ejection fraction of the left ventricle (68.8 vs. 74.6 ± 0.1%, p = 0.011), higher end-systolic volume (45 ± 24 [23 ± 11] vs. 33 ± 12 [18 ± 5] ml [ml/m2], p = 0.027 [p = 0.041]), greater maximum thickness of the ventricular wall (21.9 ± 5.2 vs. 16.4 ± 2.8 mm, p < 0.001) and increased left ventricular mass (192.8 ± 58.1 [98.5 ± 27.0] vs. 157.5 ± 50.4 [82.8 ± 21.5] g[g/m2], p < 0.001 [p = 0.001]). In a logistic regression analysis, only ejection fraction (p = 0.034) and maximum wall thickness (p < 0.001) were independently associated with the presence of fibrosis. Among those with myocardial fibrosis, a greater mass of fibrosis correlated with a lower ejection fraction (r = -0.42, p = 0.003), lower end-systolic volumes (r = 0.56, p < 0.001), greater maximum thickness wall (r = 0.28, p = 0.024) and increased left ventricular mass (r = 0.35, p = 0.017). On the multivariate analysis, only the stroke volume (p < 0.001) and maximum thickness (p = 0.020) were correlated with the mass of myocardial fibrosis. However, when we analyzed the burden of fibrosis in relation to left ventricular mass (percentage of fibrosis) only greater end-systolic volume was independently associated with a higher percentage of fibrosis (r = 0.48, p < 0.001). Conclusions The presence of myocardial fibrosis in patients with HCM is independently related to lower ejection fraction and higher maximum thickness of the ventricular wall. The burden of fibrosis correlated independently with a higher maximum wall thickness (mass of fibrosis) and lower end-systolic volume (mass and percentage of fibrosis).

Plasma Myeloperoxidase Levels Correlate with the Presence of Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

Purpose: Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the world. Oxidative stress plays a central role in disease progression to fibrosis and cirrhosis. Myeloperoxidase (MPO), an enzyme secreted from activated neutrophils is a source of potent oxidant species. The aim of the present study was to investigate the relationship between plasma levels of MPO and the presence of fibrosis in patients with NAFLD. Methods: Our cohort consisted of consecutive patients with biopsy-proven NAFLD. Blood was obtained from each patient at the time of biopsy and MPO level was determined using an ELISA. Histology was assessed by an experienced pathologist and patients were divided into two groups: fibrosis and no fibrosis. The stage of fibrosis was scored from 0 to 4 according to the Nonalcoholic Steatohepatitis Clinical Research Network. Results: 122 patients were included in the study, 66 with no fibrosis and 56 with fibrosis (including 21 patients with advanced fibrosis, stage 3-4). Those with fibrosis had higher BMI, triglyceride level, and HOMA-IR and lower HDL, p < 0.05 for all. More importantly, patients with fibrosis had significantly higher MPO levels than patients with no fibrosis [467.5 pmol/L (340-730) vs. 386 pmol/L (257-535), p=0.02]. After adjusting for multiple variables, the association between MPO and the presence of fibrosis remained significant. Patients with MPO level > 480 were 3 times more likely to have fibrosis than those with MPO level < 320 [odds ratio (95% CI) = 2.93 (1.19, 7.16)]. MPO level did not correlate with the presence of NASH and the NAFLD activity score. A prediction model for the presence of fibrosis was developed based on combining the MPO level, age, gender, BMI, AST, and triglyceride level with reasonable accuracy (area under the ROC curve of 0.72) (Figure).Figure: No Caption available.Conclusion: MPO as a marker of oxidative stress correlates with the presence of fibrosis in adult patients with NAFLD. Future studies are needed to externally validate our findings.

Prevalence of the hemochromatosis gene mutation in patients with nonalcoholic steatohepatitis and correlation with degree of liver fibrosis

Nonalcoholic steatohepatitis is a chronic liver disease with a high prevalence in the general population and a potential to evolve into cirrhosis. It is speculated that iron overload could be associated with liver injury and unfavorable progress in affected patients. To evaluate the prevalence of mutation of the hemochromatosis gene (HFE) in patients with nonalcoholic steatohepatitis and to correlate it with histological findings in liver specimens. Twenty-nine patients with nonalcoholic steatohepatitis were evaluated. The presence of mutation in the hemochromatosis gene (C282Y and H63D) was tested in all patients and its result was evaluated in relation to hepatic inflammatory activity, presence of fibrosis, and iron overload in the liver. The control group was composed of 20 patients with normal liver function tests and 20 patients infected with the hepatitis C virus, with elevated serum levels of aminotransferases and with chronic hepatitis as shown by biopsy. Mutation of the hemochromatosis gene (C282Y and/or H63D) was diagnosed in 16 (55.2%) patients with nonalcoholic steatohepatitis, in 12 (60%) patients with hepatitis C and in 8 (40%) patients with no liver disease. No association was found between the presence of mutation and inflammatory activity, nor with the presence of fibrosis in patients with nonalcoholic steatohepatitis. An association was found between the presence of mutation and the occurrence of iron overload in liver, but there was no association between liver iron and the occurrence of fibrosis. The findings suggest that iron does not play a major role in the pathogenesis and progression of nonalcoholic steatohepatitis, and routine tests of the hemochromatosis gene mutation in these patients should not be recommended.