Clin Mol Hepatol.
2023 Jul;29(3):705-720. 10.3350/cmh.2023.0004.
Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis
- Wong YJ1,2
- Nguyen VH3,4
- Yang HI5,6,7,8
- Li J9
- Le MH3,10
- Wu WJ11
- Han NX12
- Fong KY12
- Chen E1
- Wong C13
- Rui F14
- Xu X14
- Xue Q15
- Hu XY16
- Leow WQ17
- Goh GBB2,18
- Cheung R19,20
- Wong G21
- Wong VWS21
- Yu MW11
- Nguyen MH
20,22
- Affiliations
-
- 1Department of Gastroenterology & Hepatology, Changi General Hospital, SingHealth, Singapore
- 2SingHealth Duke-NUS Medicine Academic Clinical Program, Singapore
- 3Division of Gastroenterology and Hepatology, Stanford University Medical Centre, Palo Alto, CA, USA
- 4Harvard Medical School, Boston, MA, USA
- 5Genomics Research Centre, Academia Sinica, Taipei, Taiwan
- 6Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- 7Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- 8Biomedical Translation Research Centre, Academia Sinica, Taipei, Taiwan
- 9Department of Infectious Disease, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- 10Larner College of Medicine, University of Vermont, Burlington, VT, USA
- 11Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- 12Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 13Lane library, Stanford University School of Medicine, Palo Alto, CA, USA
- 14Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- 15Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- 16Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Chin
- 17Department of Pathology, Singapore General Hospital, Singapore
- 18Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
- 19Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Centre, Palo Alto, CA, USA
- 20Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- 21Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
- 22Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- KMID: 2543989
- DOI: http://doi.org/10.3350/cmh.2023.0004
Abstract
- Background/Aims
Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients.
Methods
We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random- effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment.
Results
We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88–95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27–0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all p≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, p<0.0001).
Conclusions
IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.
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