Risk Factors of Metabolic Dysfunction-associated Steatotic Liver Disease in a Cohort of Patients With Chronic Hepatitis B.

作者信息

Kalafateli Maria, Forlano Roberta, Barnes Eleanor, Martinez-Gili Laura, Lacey Madeleine, Sigon Giordano, Mullish Benjamin H, Mallet Vincent, Parlati Lucia, Richardson Paul, Forde Niamh, Serviddio Gaetano, Villani Rosanna, Lens Sabela, Buti Maria, Vargas Elena, Viganò Mauro, Loglio Alessandro, Lampertico Pietro, D'ambrosio Roberta, Monico Sara, Maffi Gabriele, Lombardi Rosa, Fracanzani Anna Ludovica, De Luca Chiara, Ingiliz Patrick, Mangia Alessandra, Leserre Federica, Napolitano Antonio Manuel, Piazzolla Valeria, Russo Francesco Paolo, Raimondo Giovanni, Cacciola Irene, Saitta Carlo, Lemoine Maud, Papatheodoridis George, Papatheodoridi Margarita, Samonakis Dimitrios N, O'Donnell Denise, O'Donoghue Jennifer, Abeles Robin Daniel, Pugliese Nicola, Aghemo Alessio, Berenguer Marina, Brown Ashley, Thursz Mark R, Manousou Pinelopi

机构信息

Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom; Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.

出版信息

Clin Gastroenterol Hepatol. 2025 Jul 2. doi: 10.1016/j.cgh.2025.06.014.

BACKGROUND & AIMS: Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) commonly co-exist, with conflicting data in prevalence and disease severity. We aimed to investigate these discrepancies.

METHODS

This multicenter study included consecutive patients with CHB from 19 European centers. A survey on standard of care for MASLD screening in CHB was circulated.

RESULTS

A total of 1709 patients with CHB were included; median age, 53 years (interquartile range [IQR], 42-64); males, 60.7%; body mass index (BMI), 25.6 kg/m (IQR, 14-63 kg/m); and 57.3% White. MASLD prevalence (1510 consecutive patients) was 42.3%. BMI (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19-1.36), ferritin (OR, 1.00; 95% CI, 1.00-1.00) and type 2 diabetes (OR, 2.60; 95% CI, 1.12-6.02) were independently associated with MASLD. The prevalence of advanced fibrosis was 18% (255/1420) in the whole cohort, 25.4% (162/639) among patients with CHB with MASLD, and 13.7% in those without MASLD. Independent predictors of advanced fibrosis were MASLD (OR, 2.76; 95% CI, 1.50-5.05), BMI (OR, 1.08; 95% CI, 1.02-1.15), alanine transaminase (OR, 1.01; 95% CI, 1.00-1.03), lower platelets (OR, 0.99; 95% CI, 0.98-0.99), insulin treatment (OR, 13.88; 95% CI, 2.95-65.28), and long-term antivirals (OR, 4.86; 95% CI, 2.40-9.85). During follow-up (48 months), only patients without MASLD showed significant liver stiffness measurement improvement over time (P < .001). Among patients with MASLD, Fibrosis-4 and liver stiffness measurement performed moderately at predicting advanced fibrosis (area under the receiver operating characteristic curve = 0.71 vs 0.70; P = .38) against histology. As standard of care, 68.4% of centers screened all patients with CHB for MASLD; 52.6% followed the same treatment indication in those with CHB and MASLD vs CHB only.

CONCLUSION

In this large European cohort, MASLD and fibrosis were highly prevalent among patients with CHB, whereas MASLD aggravated liver fibrosis. Though screening strategies remain inconsistent, ferritin levels, increased BMI, and type 2 diabetes may inform on the presence of MASLD. Biomarkers showed modest performance in predicting fibrosis.