Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection
Abstract Background Concurrent non-alcoholic fatty liver disease (NAFLD) is common in patients with chronic HBV infection. But the impact of fatty liver on the histologic progression of HBV infection remains controversial. Methods Consecutive HBV-infected patients who underwent liver biopsy between...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08632-y |
| _version_ | 1797453765439127552 |
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| author | Yi-Ning Dai Cheng-Fu Xu Hong-Ying Pan Mei-Juan Chen Chao-Hui Yu |
| author_facet | Yi-Ning Dai Cheng-Fu Xu Hong-Ying Pan Mei-Juan Chen Chao-Hui Yu |
| author_sort | Yi-Ning Dai |
| collection | DOAJ |
| description | Abstract Background Concurrent non-alcoholic fatty liver disease (NAFLD) is common in patients with chronic HBV infection. But the impact of fatty liver on the histologic progression of HBV infection remains controversial. Methods Consecutive HBV-infected patients who underwent liver biopsy between 2016 and 2021 were included. Alcohol consumption and other types of viral hepatitis were excluded. All biopsies were scored for grading and staging by Scheuer’s score, and the steatosis was scored as an estimate of the percentage of liver parenchyma replaced by fat. Logistic regression analyses were applied to assess the associated factors for significant liver inflammation (G ≥ 2), significant fibrosis (S ≥ 2) and advanced fibrosis (S ≥ 3). Results Among the 871 HBV-infected patients, hepatic steatosis was prevalent in 255 patients (29.28%). Significant liver inflammation was present in 461 patients (52.93%). Significant fibrosis was observed in 527 patients (60.51%), while advanced liver fibrosis was observed in 171 patients (19.63%). Patients with concomitant NAFLD were more likely to have significant liver inflammation and advanced fibrosis. Fatty liver was an independent risk factor for significant liver inflammation (OR: 2.117, 95% CI: 1.500-2.988), but it could not predict the development of fibrosis. Especially, in HBV-infected patients with persistent normal ALT (immune tolerant and inactive carrier phase), the presence of significant liver inflammation was higher in NAFLD than those without NAFLD. The prevalence of advanced liver fibrosis was higher in NAFLD than non-NAFLD only in the immune tolerant phase, while NAFLD did not increase fibrosis burden in other stages of HBV infection. We developed a predictive model for significant liver inflammation with the area under receiver operating characteristic curve (AUROC) of 0.825, and a model for significant fibrosis with the AUROC of 0.760. Conclusions NAFLD is independently associated with significant liver inflammation, and increases the burden of advanced liver fibrosis in HBV-infected patients. The influence of NAFLD on the degree of liver inflammation and fibrosis is different in distinct clinical phases of chronic HBV infection. |
| first_indexed | 2024-03-09T15:27:35Z |
| format | Article |
| id | doaj.art-c03ce307b1894e5b8c043a9806c1d236 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-09T15:27:35Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-c03ce307b1894e5b8c043a9806c1d2362023-11-26T12:26:52ZengBMCBMC Infectious Diseases1471-23342023-09-0123111110.1186/s12879-023-08632-yFatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infectionYi-Ning Dai0Cheng-Fu Xu1Hong-Ying Pan2Mei-Juan Chen3Chao-Hui Yu4Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of MedicineDepartment of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of MedicineCenter for General Practice Medicine, Department of Infectious Diseases, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)Center for General Practice Medicine, Department of Infectious Diseases, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of MedicineAbstract Background Concurrent non-alcoholic fatty liver disease (NAFLD) is common in patients with chronic HBV infection. But the impact of fatty liver on the histologic progression of HBV infection remains controversial. Methods Consecutive HBV-infected patients who underwent liver biopsy between 2016 and 2021 were included. Alcohol consumption and other types of viral hepatitis were excluded. All biopsies were scored for grading and staging by Scheuer’s score, and the steatosis was scored as an estimate of the percentage of liver parenchyma replaced by fat. Logistic regression analyses were applied to assess the associated factors for significant liver inflammation (G ≥ 2), significant fibrosis (S ≥ 2) and advanced fibrosis (S ≥ 3). Results Among the 871 HBV-infected patients, hepatic steatosis was prevalent in 255 patients (29.28%). Significant liver inflammation was present in 461 patients (52.93%). Significant fibrosis was observed in 527 patients (60.51%), while advanced liver fibrosis was observed in 171 patients (19.63%). Patients with concomitant NAFLD were more likely to have significant liver inflammation and advanced fibrosis. Fatty liver was an independent risk factor for significant liver inflammation (OR: 2.117, 95% CI: 1.500-2.988), but it could not predict the development of fibrosis. Especially, in HBV-infected patients with persistent normal ALT (immune tolerant and inactive carrier phase), the presence of significant liver inflammation was higher in NAFLD than those without NAFLD. The prevalence of advanced liver fibrosis was higher in NAFLD than non-NAFLD only in the immune tolerant phase, while NAFLD did not increase fibrosis burden in other stages of HBV infection. We developed a predictive model for significant liver inflammation with the area under receiver operating characteristic curve (AUROC) of 0.825, and a model for significant fibrosis with the AUROC of 0.760. Conclusions NAFLD is independently associated with significant liver inflammation, and increases the burden of advanced liver fibrosis in HBV-infected patients. The influence of NAFLD on the degree of liver inflammation and fibrosis is different in distinct clinical phases of chronic HBV infection.https://doi.org/10.1186/s12879-023-08632-yChronic HBV infectionNon-alcoholic fatty liver diseaseSignificant liver inflammationSignificant fibrosisAdvanced liver fibrosisNatural history |
| spellingShingle | Yi-Ning Dai Cheng-Fu Xu Hong-Ying Pan Mei-Juan Chen Chao-Hui Yu Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection BMC Infectious Diseases Chronic HBV infection Non-alcoholic fatty liver disease Significant liver inflammation Significant fibrosis Advanced liver fibrosis Natural history |
| title | Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection |
| title_full | Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection |
| title_fullStr | Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection |
| title_full_unstemmed | Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection |
| title_short | Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection |
| title_sort | fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic hbv infection |
| topic | Chronic HBV infection Non-alcoholic fatty liver disease Significant liver inflammation Significant fibrosis Advanced liver fibrosis Natural history |
| url | https://doi.org/10.1186/s12879-023-08632-y |
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