Hepatic steatosis and fibrosis in patients with thalassemia major: A cross-sectional study using transient elastography

Objective: This study aimed to assess the prevalence and severity of hepatic steatosis and fibrosis in patients with transfusion-dependent thalassemia major (TM) using transient elastography (TE) and to investigate their correlations with serum ferritin, liver enzymes, and body mass index (BMI). Methods: A cross-sectional study was conducted at the Thalassemia Centre in Najaf, Iraq, from January to June 2024. Eighty TM patients aged ≥12 years were enrolled. Liver stiffness and controlled attenuation parameter (CAP) were measured via TE to stage fibrosis (F0-F4) and grade steatosis (S0-S3). Serum levels of alanine transaminase (ALT), aspartate transaminase (AST), and ferritin were analysed. Statistical analyses included Spearman's correlation and binary logistic regression. Results: The mean age of participants was 22±6.3 years, with a mean BMI of 20.5±3.0 kg/m². Significant fibrosis (F3-F4) was present in 32.5% of patients, while 67.5% had no or mild fibrosis (F0-F2). Severe steatosis (S3) was found in 8.6% of patients. ALT and AST levels showed a significant positive correlation with fibrosis stage (p<0.001 for both). Serum ferritin was significantly higher in patients with significant fibrosis (p=0.012). No significant correlations were found between steatosis and ALT (p=0.275), AST (p=0.375), BMI (p=0.835), or ferritin (p=0.323). BMI was not correlated with fibrosis (p=0.193). Conclusions: Elevated liver enzymes and serum ferritin are significantly associated with liver fibrosis in TM patients, while steatosis appears less prevalent and is not correlated with traditional metabolic risk factors like BMI. Transient elastography is a crucial non-invasive tool for the simultaneous assessment of fibrosis and steatosis in high-risk populations.