All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease

Abstract

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 (CMRF). 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 hepatitis B e antigen positivity and lower hepatitis B virus 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 [aHR]: 1.79, 95% confidence interval [CI]: 1.24–2.58, p=0.002). Furthermore, cumulative CMRF 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 non-SLD patients after propensity score matching (HR: 0.62, 95% CI: 0.53 – 0.74, p<0.001).

Conclusions

Among patients with CHB and SLD, metabolic burden dose-dependently increases the 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.