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All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease
Shang-Chin Huang1, Tung-Hung Su2, Tai-Chung Tseng3
1Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) increases mortality in chronic hepatitis B (CHB) patients. Managing metabolic factors is key for better survival in CHB with SLD.
Area of Science:
- Hepatology
- Metabolic Diseases
- Public Health
Background:
- Steatotic liver disease (SLD) is common in chronic hepatitis B (CHB) patients.
- The impact of metabolic dysfunction-associated SLD (MASLD) on long-term survival in CHB patients is not well understood.
Purpose of the Study:
- To investigate the mortality risks associated with concurrent SLD in patients with CHB.
- To evaluate the influence of metabolic burden on survival outcomes in this population.
Main Methods:
- Retrospective study of 8,718 CHB patients with concurrent SLD.
- MASLD defined by cardiometabolic risk factors; mortality compared between MASLD and non-MASLD groups.
- Analysis of cumulative risk factors and incident metabolic conditions on mortality.
Main Results:
- MASLD group showed higher all-cause mortality (aHR 1.79).
- Cumulative metabolic risk factors and new-onset diabetes, hypertension, or weight gain significantly increased mortality risks.
- Patients with SLD had a lower mortality risk than those without SLD (HR 0.62).
Conclusions:
- Metabolic burden in CHB patients with SLD dose-dependently elevates risks of all-cause, liver-related, and cardiovascular mortality.
- Identifying and managing metabolic dysfunctions is crucial for risk stratification and improved care.
- SLD itself was associated with lower mortality in this cohort, highlighting the dominant role of metabolic factors.
Background & Aims:
Steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB). However, the effects of metabolic dysfunction-associated SLD (MASLD) on the long-term survival of such patients remain unknown. Accordingly, this study investigated the mortality risks in patients with CHB and concurrent SLD.
Methods:
Consecutive patients with CHB and concurrent SLD were retrospectively recruited at National Taiwan University Hospital. MASLD was defined by the presence of cardiometabolic risk factors. The cumulative incidences of all-cause and cause-specific mortality were compared.
Results:
A total of 8,718 patients with CHB and concurrent SLD were included from 2006 to 2021. At baseline, the MASLD group (n = 6,562) was older and had a lower proportion of HBeAg positivity and lower HBV DNA levels compared with the non-MASLD group (n = 2,156). After a median follow-up period of 9.1 years, the MASLD group exhibited a higher risk of all-cause mortality compared with the non-MASLD group (adjusted hazard ratio 1.79, 95% CI 1.24-2.58, p = 0.002). Furthermore, cumulative cardiometabolic risk factors dose-dependently elevated the risks of all-cause, liver-related, and cardiovascular mortality (all p <0.05). During the follow-up period, new-onset diabetes mellitus, hypertension, and significant weight gain further increased the risks of all-cause and liver-related mortality (all p <0.05). However, patients with SLD had a lower mortality risk than those without SLD after propensity score matching (hazard ratio 0.62, 95% CI 0.53-0.74, p <0.001).
Conclusions:
Among patients with CHB and SLD, metabolic burden dose-dependently increases all-cause, liver-related, and cardiovascular mortality risks. Patients with SLD have a lower mortality risk than those without SLD. Identifying these metabolic dysfunctions is crucial for stratifying the level of risk in daily care.
Impact And Implications:
Concurrent steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB); however, the effects of the associated cardiometabolic risk factors on all-cause and cause-specific mortality remain unknown. This study demonstrated that cumulative metabolic burden dose-dependently increased the risks of all-cause, liver-related, and cardiovascular mortality in patients with CHB and SLD. Moreover, new-onset diabetes mellitus, hypertension, and weight gain during the follow-up period further exacerbated these risks. However, patients with SLD had a lower risk of mortality than those without SLD. Thus, routine screening and monitoring of metabolic dysfunctions constitute a key element of daily care for patients with CHB.
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