Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load
Background & Aims: Liver steatosis may occur concomitantly in patients with chronic hepatitis B infection (CHB) and is implicated in increased morbidity and mortality. Hepatitis B virus (HBV) viral load is a marker for disease progression and long-term outcomes in CHB. We investigated the associ...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-05-01
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| Series: | JHEP Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555919300096 |
| _version_ | 1828932045182599168 |
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| author | Noam Peleg Assaf Issachar Orly Sneh Arbib Michal Cohen-Naftaly Marius Braun Moshe Leshno Alon Barsheshet Amir Shlomai |
| author_facet | Noam Peleg Assaf Issachar Orly Sneh Arbib Michal Cohen-Naftaly Marius Braun Moshe Leshno Alon Barsheshet Amir Shlomai |
| author_sort | Noam Peleg |
| collection | DOAJ |
| description | Background & Aims: Liver steatosis may occur concomitantly in patients with chronic hepatitis B infection (CHB) and is implicated in increased morbidity and mortality. Hepatitis B virus (HBV) viral load is a marker for disease progression and long-term outcomes in CHB. We investigated the association between liver steatosis and HBV viral load and their individual effects on all-cause mortality and the development of cancer in patients with CHB and liver steatosis. Methods: This retrospective study included 524 treatment-naïve patients with CHB, with a mean follow-up of 6 years. Liver biopsy was available for 170 patients and liver steatosis was validated by at least 3 ultrasonographic examinations. Results: A total of 241/524 (46%) patients with CHB had liver steatosis, with a strong correlation between the degree of liver steatosis as assessed by ultrasonography or by liver biopsy (r = 0.9, p <0.001). Although liver steatosis was not significantly associated with advanced fibrosis, a multivariate analysis showed that liver steatosis was associated with a 4-fold increased risk of all-cause mortality and cancer (hazard ratio 4.35; 95% CI 1.69–8.99; p <0.001), irrespective of other major metabolic factors. However, baseline HBV viral load was not significantly associated with this composite outcome (hazard ratio 1.65; p = 0.29). In addition, liver steatosis was inversely associated with HBV viral load. Conclusion: Patients with CHB and liver steatosis have an increased risk of all-cause mortality and cancer development compared to patients with CHB without liver steatosis, regardless of their baseline HBV viral load. Although tending to have a lower baseline viral load, patients with CHB and liver steatosis should be closely monitored irrespective of viral load. Lay summary: Patients with chronic hepatitis B infection (CHB) may have liver steatosis at the same time. Here we show that in patients with CHB, liver steatosis is significantly associated with all-cause mortality and cancer, irrespective of other major metabolic factors, and the effect of liver steatosis on mortality and cancer is stronger than the effect of hepatitis B viral load on these outcomes. Thus, patients with CHB and liver steatosis should be closely monitored, irrespective of their viral load. Keywords: Non-alcoholic fatty liver disease, viremia, prognosis |
| first_indexed | 2024-12-14T00:56:10Z |
| format | Article |
| id | doaj.art-bfc9d5e204964a69bf7a62aee0e07f07 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-12-14T00:56:10Z |
| publishDate | 2019-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-bfc9d5e204964a69bf7a62aee0e07f072022-12-21T23:23:33ZengElsevierJHEP Reports2589-55592019-05-0111916Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral loadNoam Peleg0Assaf Issachar1Orly Sneh Arbib2Michal Cohen-Naftaly3Marius Braun4Moshe Leshno5Alon Barsheshet6Amir Shlomai7Department of Medicine D, Rabin Medical Center, Beilinson hospital, Petach-Tikva, IsraelDepartment of Medicine D, Rabin Medical Center, Beilinson hospital, Petach-Tikva, Israel; The Liver Institute, Rabin Medical Center, Beilinson hospital, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelThe Liver Institute, Rabin Medical Center, Beilinson hospital, Petach-Tikva, IsraelThe Liver Institute, Rabin Medical Center, Beilinson hospital, Petach-Tikva, IsraelThe Liver Institute, Rabin Medical Center, Beilinson hospital, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelColler School of Management, Tel Aviv University, Tel Aviv, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petach-Tikva, IsraelDepartment of Medicine D, Rabin Medical Center, Beilinson hospital, Petach-Tikva, Israel; The Liver Institute, Rabin Medical Center, Beilinson hospital, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Corresponding author. Address: Department of Medicine D and the Liver Institute, Rabin Medical Center, Beilinson hospital, 39 Jabotinsky street, Petach-Tikva, Israel or The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Background & Aims: Liver steatosis may occur concomitantly in patients with chronic hepatitis B infection (CHB) and is implicated in increased morbidity and mortality. Hepatitis B virus (HBV) viral load is a marker for disease progression and long-term outcomes in CHB. We investigated the association between liver steatosis and HBV viral load and their individual effects on all-cause mortality and the development of cancer in patients with CHB and liver steatosis. Methods: This retrospective study included 524 treatment-naïve patients with CHB, with a mean follow-up of 6 years. Liver biopsy was available for 170 patients and liver steatosis was validated by at least 3 ultrasonographic examinations. Results: A total of 241/524 (46%) patients with CHB had liver steatosis, with a strong correlation between the degree of liver steatosis as assessed by ultrasonography or by liver biopsy (r = 0.9, p <0.001). Although liver steatosis was not significantly associated with advanced fibrosis, a multivariate analysis showed that liver steatosis was associated with a 4-fold increased risk of all-cause mortality and cancer (hazard ratio 4.35; 95% CI 1.69–8.99; p <0.001), irrespective of other major metabolic factors. However, baseline HBV viral load was not significantly associated with this composite outcome (hazard ratio 1.65; p = 0.29). In addition, liver steatosis was inversely associated with HBV viral load. Conclusion: Patients with CHB and liver steatosis have an increased risk of all-cause mortality and cancer development compared to patients with CHB without liver steatosis, regardless of their baseline HBV viral load. Although tending to have a lower baseline viral load, patients with CHB and liver steatosis should be closely monitored irrespective of viral load. Lay summary: Patients with chronic hepatitis B infection (CHB) may have liver steatosis at the same time. Here we show that in patients with CHB, liver steatosis is significantly associated with all-cause mortality and cancer, irrespective of other major metabolic factors, and the effect of liver steatosis on mortality and cancer is stronger than the effect of hepatitis B viral load on these outcomes. Thus, patients with CHB and liver steatosis should be closely monitored, irrespective of their viral load. Keywords: Non-alcoholic fatty liver disease, viremia, prognosishttp://www.sciencedirect.com/science/article/pii/S2589555919300096 |
| spellingShingle | Noam Peleg Assaf Issachar Orly Sneh Arbib Michal Cohen-Naftaly Marius Braun Moshe Leshno Alon Barsheshet Amir Shlomai Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load JHEP Reports |
| title | Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load |
| title_full | Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load |
| title_fullStr | Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load |
| title_full_unstemmed | Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load |
| title_short | Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load |
| title_sort | liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis b regardless of viral load |
| url | http://www.sciencedirect.com/science/article/pii/S2589555919300096 |
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