Metabolic comorbidities in chronic hepatitis B are associated with elevated risks for liver-related events

Question:

The scientific question of this study was to investigate whether nonalcoholic fatty liver disease (NAFLD) and metabolic diseases correlate with hepatic disease progression in chronic Hepatitis B (CHB).

Methods:

We analysed a single-center cohort of 652 patients with CHB who were referred to the University Medical Center Hamburg-Eppendorf between 2008 and 2016 by retrospective chart review. 49 patients were excluded due to coinfection with Hepatitis C, D or HIV as well as liver-related events before baseline. The total cohort was classified into subgroups of HBV-infected patients with history of diabetes, obesity, coronary heart disease, hypertension or NAFLD. Baseline characteristics as well as incidences of liver-related events during follow-up (hepatocellular carcinoma, liver transplantation and liver-related death) were compared between the indicated subgroups and the total cohort.

Results:

36.47% of patients in the total cohort were treated with Nucleo(s)tid analogues (NUCs) and median serum HBV DNA was 1.71 × 103 IU/ml at baseline. Rates of liver cirrhosis were significantly higher in HBV patients suffering from diabetes (11/23, 47.83%), obesity (7/14, 50%), coronary heart disease (7/11, 63.64%) or hypertension (24/44, 54.55%) compared to those with NAFLD (4/39, 10.26%) and the total cohort (82/603, 13.6%) at baseline. Liver-related events occurred in 2.59% of the patients in the total cohort during follow-up, but were more frequent in metabolic subgroups (diabetes: 13.04%, obesity: 14.29%, hypertension: 9.09%, coronary heart disease: 18.18%). By contrast, no clinical events were detected in the NAFLD group. The existence of obesity (p = 0.011), hypertension (p = 0.001) or coronary heart disease (p = 0.006) at baseline correlated significantly with the occurrence of liver-related events analysed by logistic regression, while the absence of NUC therapy at baseline did not correlate with the indicated hepatic events within the total cohort.

Conclusions:

The increased incidence of liver-related events in patients harbouring metabolic comorbidities despite the availability of potent viral suppressors suggests a future relevance of metabolic disorders in the prevention of HBV disease progression. The data of this study underline the importance to consistently monitor and treat metabolic comorbidities in CHB. Finally, the fact that extrahepatic metabolic disorders, but not hepatic steatosis were associated with liver-related events, illustrates that the impact of extrahepatic metabolic factors on CHB disease progression is not fully understood and needs to be elucidated by future studies.