Prognostic Relevance of Metabolic Dysfunction-associated Steatohepatitis for Patients with Chronic Hepatitis B

Background and Aims: Metabolic dysfunction-associat-ed fatty liver disease (MAFLD) is prevalent in patients with chronic hepatitis B (CHB). The effect of the histologic MAFLD phenotype on long-term CHB outcomes is unknown. We per-formed a longitudinal study to determine the prognostic rel-evance of biopsy-proven hepatic steatosis and steatohepati-tis for CHB patients. Methods: Clinical and laboratory data were obtained from CHB patients who underwent liver biopsy during 2002???2008 and were treated with antiviral drugs. A hepatopathologist reviewed the biopsy specimens. Cox pro-portional hazards regression was used to estimate the ad-justed hazard ratio (aHR) of outcomes, including all-cause mortality, liver transplantation, and liver-related events. Re-sults: In accordance with Brunt???s classification, 408 patients had steatohepatitis (n=34), ???steatosis but not steatohepati-tis??? (n=118), or ???non-steatosis??? (n=256). All steatohepatitis patients had features of metabolic dysfunction. Over a mean follow-up of 13.8??3.1 years, 18 patients died or underwent liver transplantation. In multivariate-adjusted analysis, stea-tohepatitis (aHR, 6.37; 95% confidence interval [CI]: 1.59??? 25.5) compared with non-steatosis and advanced fibrosis (aHR, 11.3; 95% CI: 1.32???96.3) compared with no fibrosis were associated with overall mortality/liver transplantation. Thirty-five patients developed 43 liver-related events, among which 32 were hepatocellular carcinoma. These events were associated with steatohepatitis (aHR, 5.55; 95% CI: 2.01??? 15.3) compared with non-steatosis and advanced fibrosis (aHR, 6.23; 95% CI: 1.75???22.2) compared with no fibro-sis. The steatosis but not steatohepatitis group had a non-significantly higher risk of overall mortality and liver-related events. Conclusions: Metabolic dysfunction-associated ste-atohepatitis increased the risk of long-term mortality/trans-plantation and liver-related events in CHB patients.