Metabolic burden ups risk of death in CHB patients with SLD

Metabolic burden in patients with chronic hepatitis B (CHB) and concurrent steatotic liver disease (SLD) may exacerbate the risks of all-cause, liver-related, and cardiovascular mortality, suggests a study.

However, patients with SLD appear to be at lower risk of death than those without SLD.

A total of 8,718 consecutive patients with CHB and SLD at National Taiwan University Hospital were retrospectively recruited in this study from 2006 to 2021. Metabolic dysfunction-associated SLD (MASLD) was characterized by the presence of cardiometabolic risk factors. The investigators then compared the cumulative incidences of all-cause and cause-specific mortality.

At baseline, patients with MASLD (n=6,562) were older and were less likely to have HBeAg positivity and lower HBV DNA levels than those without MASLD (n=2,156).

The MASLD group showed a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.79, 95 percent confidence interval [CI], 1.24–2.58; p=0.002) than the non-MASLD group after a median follow-up period of 9.1 years.

In addition, cumulative cardiometabolic risk factors increased the risks of all-cause, liver-related, and cardiovascular deaths in a dose-dependent manner (p<0.05 for all). During follow-up, patients with new-onset diabetes mellitus, hypertension, and significant weight gain had further increases in all-cause and liver-related mortality risks (p<0.05 for all).

On the other hand, patients with SLD exhibited a reduced mortality risk relative to those without SLD following propensity score matching (HR, 0.62, 95 percent CI, 0.53–0.74; p<0.001).

“Identifying these metabolic dysfunctions is crucial for stratifying the level of risk in daily care,” the investigators said. 

“Thus, routine screening and monitoring of metabolic dysfunctions constitute a key element of daily care for patients with CHB,” they noted.