The relationship between cryoglobulin and severity of liver lesions is debated.No study has focused on the relationship between cryoglobulin,liver steatosis,and fibrosis.The aim of this study was to determine the relationship between cryoglobulins and liver lesions(necroinflammation,fibrosis,and steatosis) in patients with hepatitis C virus(HCV) infection.Four hundred and thirty-seven consecutive patients with untreated chronic hepatitis C who had been admitted for liver biopsy were included in the study.Risk factors for fibrosis and steatosis were assessed.The mean age was 50.9 ± 13.8 years,and 49% were male.Cryoglobulin was present in 286 patients,103 of whom had vasculitis.One hundred and eighty-six patients(43%) had steatosis greater than 10%,and 110(25%) had advanced fibrosis(Metavir score F3-F4) .On multivariate analysis,cryoglobulin increased by nearly threefold the risk of having advanced fibrosis and steatosis greater than 10%.Steatosis greater than 10% was associated with a higher body mass index(P <.001) ,HCV genotype 3(P <.001) ,cryoglobulin(P =.002) ,and advanced liver fibrosis(P =.009) .Advanced fibrosis(F3-F4) was associated with a higher level of γ-glutamyltransferase(P =.04) ,cryoglobulin(P<.001) ,a high grade of necroinflammation(Metavir score A2-A3) (P <.001) ,and steatosis higher than 10%(P =.04) .In conclusion,our study shows an independent association between cryoglobulin and steatosis as well as advanced fibrosis. The relationship between cryoglobulin and severity of liver lesions is debated. No study has focused on the relationship between cryoglobulin, liver steatosis, and fibrosis. The aim of this study was to determine the relationship between cryoglobulins and liver lesions (necroinflammation, fibrosis, and steatosis ) in patients with hepatitis C virus (HCV) infection. Four hundred and thirty-seven consecutive patients with untreated chronic hepatitis C who had been admitted for liver biopsy were included in the study. Ruf factors for fibrosis and steatosis were. The. was 50.9 ± 13.8 years, and 49% were male. Cryoglobulin was present in 286 patients, 103 of whom had vasculitis. One hundred and eighty-six patients (43%) had steatosis greater than 10%, and 110 (25%) had An advanced fibrosis (Metavir score F3-F4) .On multivariate analysis, cryoglobulin increased by nearly threefold the risk of having advanced fibrosis and steatosis greater than 10% .Steatosis greater than 10% was associated with a higher body mass index (P <.001), HCV genotype 3 (P <.001), cryoglobulin (P = .002), and advanced liver fibrosis a higher level of γ-glutamyltransferase (P = .04), cryoglobulin (P <.001), a high grade of necroinflammation (Metavir score A2-A3) . Conclusion) our conclusion shows an independent association between cryoglobulin and steatosis as well as advanced fibrosis.