Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load

Abstract

Highlights• HBV viral load is an important predictor of adverse outcomes in patients with chronic HBV (CHB).• Liver steatosis may co-occur with CHB but its effect on all-cause mortality and cancer has not been determined.• Liver steatosis is significantly associated with allcause mortality and cancer in patients with CHB.• The effect of liver steatosis on mortality and cancer is stronger than the effect of HBV viral load.• Patients with CHB and liver steatosis should be closely monitored, irrespective of their viral load.

Nonalcoholic Steatohepatitis Is Associated With Liver‐Related Outcomes and All‐Cause Mortality in Chronic Hepatitis B

“…Our study noted significance for histological determinants of NASH such as ballooning and inflammation, but not steatosis, for clinical events in the overall cohort. In contrast, a recent retrospective study from the Middle East showed that concomitant steatosis predicts mortality and cancer in CHB patients, even when adjusted for other major metabolic factors . However, steatosis was diagnosed predominantly by ultrasound, and their multivariable analysis included covariates such as FIB‐4 and aspartate aminotransferase‐to‐platelet ratio index as surrogates for fibrosis but not AF and steatohepatitis on biopsy.…”

“…In contrast, a recent retrospective study from the Middle East showed that concomitant steatosis predicts mortality and cancer in CHB patients, even when adjusted for other major metabolic factors. (37) However, steatosis was diagnosed predominantly by ultrasound, and their multivariable analysis included covariates such as FIB-4 and aspartate aminotransferase-toplatelet ratio index as surrogates for fibrosis but not AF and steatohepatitis on biopsy. Despite differences in patient demographics, disease severity, increased HCC, and assessment of NASH as a comorbid disease state in CHB, our findings are otherwise consistent with NAFLD studies which identified AF as being the strongest predictor of clinical outcomes.…”

Chronic hepatitis B and non‐alcoholic fatty liver disease: Conspirators or competitors?

“…According to a retrospective cohort study among 270 patients with CHB, biopsy‐proven liver steatosis was established as an independent risk factor (HR = 7.27) for HCC in patients with CHB following multivariable Cox analysis . Similarly, another retrospective cohort study in 524 treatment‐naïve patients with CHB showed that liver steatosis was associated with a significantly increased risk of both all‐cause mortality and cancer (HR = 4.35), which was even stronger than the risk from HBV viral load (HR = 1.65) . We hope that more large‐scale prospective cohorts will be conducted to further establish the aggravated risk of fibrosis and HCC under concomitant NAFLD and CHB, and that more details of NAFLD‐CHB‐related HCC, such as the its histological characteristics and molecular pattern, would be explored in the future.…”

“…14 Similarly, another retrospective cohort study in 524 treatment-naïve patients with CHB showed that liver steatosis was associated with a significantly increased risk of both all-cause mortality and cancer (HR = 4.35), which was even stronger than the risk from HBV viral load (HR = 1.65). 16 We hope that more large-scale prospective cohorts will be conducted to further establish the aggra- 120 both ethical issues and tremendous cost render their utility in this field nearly unrealistic. Here, we summarize new animal models that possess potential utility towards exploring the interaction between NAFLD and CHB.…”

“…However, the interplay between these two diseases remains elusive. For example, NAFLD and CHB can collectively aggravate liver injury and augment the risk of cirrhosis and HCC, acting as “notorious conspirators” jeopardizing liver health. Conversely, NAFLD appears to be positively associated with diminished HBV seromarkers in patients with CHB, with these patients also exhibiting reduced incidence of lipidemia and NAFLD, suggesting a potential “competitive relationship”.…”