Association Between the Presence of Metabolic Comorbidities and Liver-Related Events in Patients With Chronic Hepatitis B

Lesley A. Patmore*, Warshan K. Katwaroe, Daniel van der Spek, Hannah S.J. Choi, Keyur Patel, Sylvia Brakenhoff, Adriaan J. van der Meer, Willem P. Brouwer, Laurens A. van Kleef, Rob J. de Knegt, Bettina E. Hansen, Rob A. de Man, Jordan J. Feld, Harry L.A. Janssen, Milan J. Sonneveld

*Corresponding author for this work

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Abstract

Background & Aims: Patients with chronic hepatitis B (CHB) are at increased risk of hepatocellular carcinoma and (liver-related) mortality. In addition to hepatitis B–related factors, metabolic comorbidities may contribute to the progression of fibrosis. Therefore, we studied the association between metabolic comorbidities and adverse clinical outcomes in patients with CHB. Methods: We conducted a retrospective cohort study of CHB patients attending the Erasmus MC University Medical Center (Rotterdam, The Netherlands) and CHB patients who underwent liver biopsy at the Toronto General Hospital (Toronto, Canada). The presence of metabolic comorbidities (ie, overweight, diabetes mellitus, hypertension, and dyslipidemia) was assessed based on chart review. The primary end point was liver-related events, defined as the first composite of hepatocellular carcinoma, liver transplantation, or liver-related mortality. Results: We analyzed 1850 patients, of whom 926 (50.1%) were overweight, 161 (8.7%) had hypertension, 116 (6.3%) had dyslipidemia, and 82 (4.4%) had diabetes. During a median follow-up period of 7.3 years (interquartile range, 2.9–11.5 y), a total of 111 first events were recorded. Hypertension (hazard ratio [HR], 8.3; 95% CI, 5.5–12.7), diabetes (HR, 5.4; 95% CI, 3.2–9.1), dyslipidemia (HR, 2.8; 95% CI, 1.6–4.8), and overweight (HR, 1.7; 95% CI, 1.1–2.5) were associated with an increased risk for liver-related events. The presence of multiple comorbidities further increased the risk. Findings were consistent for patients with and without cirrhosis, among noncirrhotic hepatitis B e antigen–negative patients with hepatitis B virus DNA less than 2000 IU/mL and in multivariable analysis adjusting for age, sex, ethnicity, hepatitis B e antigen status, hepatitis B virus DNA, use of antiviral therapy, and the presence of cirrhosis. Conclusions: Metabolic comorbidities in CHB patients are associated with an increased risk for liver-related events, with the highest risk observed in patients with multiple comorbidities. Findings were consistent in various clinically relevant subgroups, underscoring the need for thorough metabolic assessment in patients with CHB.

Original languageEnglish
Pages (from-to)3089-3096.e1
JournalClinical Gastroenterology and Hepatology
Volume21
Issue number12
Early online date2023
DOIs
Publication statusPublished - Nov 2023

Bibliographical note

Funding Information:
Funding The study was sponsored by the Foundation for Liver and Gastrointestinal Research , Rotterdam, the Netherlands. The Foundation for Liver and Gastrointestinal Research had no influence on the study design, data acquisition or analysis, or the decision to submit for publication.

Funding Information:
Funding The study was sponsored by the Foundation for Liver and Gastrointestinal Research, Rotterdam, the Netherlands. The Foundation for Liver and Gastrointestinal Research had no influence on the study design, data acquisition or analysis, or the decision to submit for publication.

Publisher Copyright:
© 2023 The Authors

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