Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2023; 15(2): 237-254
Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.237
Baseline hepatocyte ballooning is a risk factor for adverse events in patients with chronic hepatitis B complicated with nonalcoholic fatty liver disease
You-Wen Tan, Jia-Min Wang, Xing-Bei Zhou
You-Wen Tan, Jia-Min Wang, Xing-Bei Zhou, Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
Author contributions: YW Tan and JM Wang contribute equally to research; YW Tan and XB Zhou designed the research; YW Tan and JM Wang collected and analyzed the data, and drafted the manuscript; YW Tan performed the liver pathological evaluations; YW Tan and XB Zhou wrote and revised the manuscript; All authors have read and approved the final version to be published.
Supported by the Social Development Project of Jiangsu Province, China, No. BE2020775; Chinese Federation of Public Health foundation, No. GWLM202002.
Institutional review board statement: This study was approved by the ethics committee of The Third People’s Hospital Affiliated to Zhenjiang, Jiangsu University.
Conflict-of-interest statement: The authors declare that there is no relevant conflict of interest.
Data sharing statement: The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Wen Tan, MD, Chief Doctor, Professor, Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300 Daijiamen, Runzhou Distinct, Zhenjiang 212003, Jiangsu Province, China. tyw915@sina.com
Received: November 22, 2022
Peer-review started: November 22, 2022
First decision: December 10, 2022
Revised: December 14, 2022
Accepted: January 17, 2023
Article in press: January 17, 2023
Published online: February 27, 2023
Processing time: 93 Days and 15.6 Hours
Abstract
BACKGROUND

Although many studies have investigated the impact of chronic hepatitis B virus (HBV) infection and nonalcoholic fatty liver disease (NAFLD) on liver disease, few have investigated the relationship between nonalcoholic steatohepatitis (NASH) defined by liver pathology and the prognosis of chronic HBV infection. Most patients were followed up for a short time. This study aimed to further explore the impact of NAFLD and the pathological changes confirmed by liver pathology in patients with chronic HBV infection.

AIM

To study the effect of NAFLD confirmed using liver pathology on the outcomes of long-term serious adverse events [cirrhosis, hepatocellular carcinoma (HCC), and death] in patients with chronic hepatitis B (CHB) virus infection.

METHODS

We enrolled patients with chronic hepatitis B virus (HBV) infection who underwent liver biopsy at the Third People’s Hospital of Zhenjaing Affiliated Jiangsu University between January 2005 and September 2020. Baseline clinical and pathological data on liver pathology and clinical data at the end of follow-up were collected. Propensity score matching (PSM) was used to balance baseline parameters, Kaplan-Meier (K-M) survival analysis was used to evaluate the risk of clinical events, and Cox regression was used to analyze the risk factors of events.

RESULTS

Overall, 456 patients with chronic HBV infection were included in the study, of whom 152 (33.3%) had histologically confirmed NAFLD. The median follow-up time of the entire cohort was 70.5 mo. Thirty-four patients developed cirrhosis, which was diagnosed using ultrasound during the follow-up period. K-M survival analysis showed that NAFLD was not significantly associated with the risk of cirrhosis (log-rank test, P > 0.05). Patients with CHB with fibrosis at baseline were more prone to cirrhosis (log-rank test, P = 0.046). After PSM, multivariate analysis showed that diabetes mellitus, ballooning deformation (BD), and platelet (PLT) were independent risk factors for cirrhosis diagnosed using ultrasound (P < 0.05). A total of 10 patients (2.2%) developed HCC, and six of these patients were in the combined NAFLD group. K-M survival analysis showed that the cumulative risk of HCC in the NAFLD group was significantly higher (log-rank test, P < 0.05). Hepatocyte ballooning, and severe liver fibrosis were also associated with an increased risk of HCC (log-rank test, all P < 0.05). Cox multivariate analysis revealed that hepatocyte ballooning, liver fibrosis, and diabetes mellitus were independent risk factors for HCC.

CONCLUSION

There was no significant correlation between chronic HBV infection and the risk of cirrhosis in patients with NAFLD. Diabetes mellitus, BD, and PLT were independent risk factors for liver cirrhosis. Patients with chronic HBV infection and NASH have an increased risk of HCC. BD, liver fibrosis, and diabetes mellitus are independent risk factors for HCC.

Keywords: Nonalcoholic fatty liver disease; Steatohepatitis; Chronic hepatitis B virus infection; Hepatocellular carcinoma; Cirrhosis

Core Tip: A total of 456 patients with chronic hepatitis B virus infection were included in the study, of whom 152 (33.3%) had histologically confirmed nonalcoholic fatty liver disease (NAFLD). The median follow-up time of the entire cohort was 70.5 mo. Kaplan-Meier (K-M) survival analysis showed that NAFLD was not significantly associated with the risk of cirrhosis. Patients with chronic hepatitis B with fibrosis at baseline were more prone to cirrhosis. After PSM, multivariate analysis showed that diabetes mellitus, ballooning deformation, and platelet were independent risk factors for cirrhosis. A total of 10 patients (2.2%) developed hepatocellular carcinoma (HCC). K-M survival analysis showed that the cumulative risk of HCC in the NAFLD group was significantly higher. Cox multivariate analysis revealed that hepatocyte ballooning, liver fibrosis, and diabetes mellitus were independent risk factors for HCC.