Revaluation of clinical and histological criteria for diagnosis of dysmetabolic iron overload syndrome

Table 1 Main clinical, biochemical and histological data of the HIO patients (as a whole and according to gender) and HFE controls

				HIO
	HIO (n = 81)	P	HFE-HH (n = 57)	Men (n = 67)	P	Women (n = 14)
Age (yr)	52 (28-76)	> 0.05	50 (26-71)	54 (28-76)	> 0.05	51 (29-70)
Transferrin saturation (%)	39 (21-118)	< 0.0001	76 (29-100)	38 (21-118)	0.02	56 (28-99)
Serum ferritin (μg/L)	982 (413-5050)	> 0.05	1100 (274-10 990)	964 (413-5050)	> 0.05	1286 (520-3987)
AST (U/L)	27 (12-174)	> 0.05	27 (17-87)	27 (12-174)	> 0.05	28 (13-65)
ALT (U/L)	38 (11-271)	> 0.05	43 (11-114)	38 (14-271)	> 0.05	36 (11-118)
Total Iron Score	19 (12-46)	0.0071	24 (8-49)	18 (12-40)	0.0006	32 (12-46)
Hepatocytic iron score	15 (6-27)	0.001	18 (3-27)	12 (6-27)	0.0022	21 (9-27)
Sinusoidal iron score	5 (3-8)	< 0.0001	3 (0-10)	5 (3-7)	> 0.05	6 (3-8)
Portal iron score	0 (0-12)	0.0002	2 (0-12)	0 (0-8)	< 0.0001	3.5 (0-12)
SIS/TIS	0.25 (0.09-0.5)	< 0.0001	0.13 (0-0.63)	0.25 (0.10-0.5)	0.001	0.16 (0.09-0.29)
HHII	0.38 (0.20-1.21)	0.0012	0.53 (0.15-0.97)	0.36 (0.20-1.08)	0.004	0.64 (0.23-1.21)
Hepatic fibrosis (Ishak’s score)	34 (42)	> 0.05	33 (57.8)	26 (38.8)	> 0.05	8 (57.1)
Hepatic cirrhosis (Ishak’s score)	7 (8.6)	0.027	13 (22.8)	3 (4.5)	0.015	4 (28.6)
Patients with hepatic steatosis	47 (58)	0.015	20 (36.3)	41 (61.2)	> 0.05	6 (42.9)
Patients with moderate-severe hepatic steatosis	35 (43.2)	< 0.0001	6 (10.5)	31 (46.3)	> 0.05	4 (28.6)
Metabolic syndrome	20 (24.7)	> 0.05	91 (16.1)	19 (28.4)	> 0.05	1 (7.1)

Data are reported as median (range) or number (%). Hepatic steatosis: > 5% of hepatocytes involved by steatosis; Moderate-severe steatosis: ≥ 33% of hepatocytes involved by steatosis.

¹Not available in one HFE-control. SIS/TIS: Sinusoidal/total iron score; HHII: Histological hepatic iron index (ratio of TIS to age).

Table 2 Correlation between total iron score (TIS) and several parameters in HIO patients

	r	P
Hepatocytic iron score	0.94	< 0.0001
Sinusoidal iron score	0.54	< 0.0001
Portal iron score	0.58	< 0.0001
Serum ferritin (μg/L)	0.53	< 0.0001
Transferrin saturation (%)	0.43	< 0.0001
Age (yr)	0.23	0.04
Hepatic fibrosis	0.28	0.012
Body mass index (kg/m2)	-0.48	< 0.0001
Degree of hepatic steatosis	-0.53	< 0.0001
No. of components of MS	-0.33	0.0026
HOMA index	-0.3	0.0125

Degree of hepatic steatosis refers to the percentage of hepatocytes involved by steatosis. Hepatic fibrosis refers to Ishak’s score.

Table 3 Correlation between number of MS components and several parameters in HIO patients

	r	P
Age (yr)	0.3	0.0055
Degree of hepatic steatosis (%)	0.57	< 0.0001
HOMA index	0.59	< 0.0001
Transferrin saturation (%)	-0.25	0.0293
Total iron score	-0.33	0.0053
Histological hepatic iron index	-0.53	< 0.0001
Sinusoidal iron score/Total iron score	0.13	> 0.05

Degree of hepatic steatosis refers to the percentage of hepatocytes involved by steatosis.

Table 4 Iron indices in patients according to the presence of ≥ 2 components of MS or steatosis

	Number of MS components			Hepatic steatosis
	0-1 (n = 34)	P	≥2 (n = 47)	Absent (n = 34)	P	Present (n = 47)
Transferrin saturation (%)	44 (28-118)	0.0058	36 (21-99)	39 (23-118)	> 0.05	39 (21-76)
Total Iron Score	24 (12-46)	0.0008	17 (12-39)	24.5 (12-46)	< 0.0001	16 (12-39)
HHII	0.51 (0.3-1.21)	< 0.0001	0.33 (0.2-0.57)	0.43 (0.23-1.1)	0.0004	0.34 (0.19-1.2)
SIS/TIS	0.21 (0.1-0.5)	0.0185	0.25 (0.11-0.4)	0.22 (0.1-0.5)	0.032	0.25 (0.09-0.4)
MS components ≥ 2	-		-	11 (32)	< 0.0001	36 (77)
Degree of hepatic steatosis (%)	0 (0-80)	< 0.0001	40 (0-98)	-		-

Data are reported as median (range) or number (%). HHII: Histological hepatic iron index (ratio of TIS to age); SIS/TIS: Sinusoidal/total iron score. Hepatic steatosis, absent when ≤ 5% of hepatocytes are involved; present when at least 5% of hepatocytes are involved.