Analysis of factors affecting early hepatic steatosis in pediatric patients with Wilson’s disease in China: A retrospective study

Hepatic steatosis frequently emerges as one of the earliest clinical features of Wilson's disease (WD), particularly in pediatric populations. This study aimed to investigate the relationship between demographic characteristics, biochemical indicators, and lipid metabolism markers with hepatic steatosis in children diagnosed with WD. Although noninvasive imaging techniques such as acoustic attenuation parameter and liver stiffness measurement were employed to assess hepatic changes, the primary focus was not on imaging validation. A retrospective observational study was conducted among 239 pediatric patients with WD treated at the Center for Encephalopathy, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, from 2021 to 2024. Serological and imaging data were collected to evaluate hepatic steatosis, defined by acoustic attenuation parameter thresholds. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of hepatic steatosis. The cohort had a mean age of 14.0 years (range: 11.0-16.0), with 160 males (66.95%) and 79 females (33.05%). The average disease duration was 5.0 years. In multivariable logistic regression, higher alanine aminotransferase and triglycerides were independently associated with hepatic steatosis, while high-density lipoprotein cholesterol showed an inverse association. Aspartate aminotransferase was not significant after adjustment. In this single-center retrospective cohort, alanine aminotransferase and triglycerides were independently associated with hepatic steatosis in this analysis. These observational findings require external and prospective validation before informing clinical decision-making.