Fatty liver is associated with significant liver inflammation but does not increase fibrosis burden in Chronic Hepatitis B

Abstract Background: Concurrent non-alcoholic fatty liver disease (NAFLD) is common in patients with chronic hepatitis B (CHB). But the impact of fatty liver on the histologic progression of CHB remains controversial.Methods: Consecutive CHB patients who underwent liver biopsy between 2016 and 2021 were included. Alcohol consumption and other types of viral hepatitis were excluded. All biopsies were scored for grading and staging by Scheuer’s score, and the steatosis was scored as an estimate of the percentage of liver parenchyma replaced by fat. Logistic regression analyses were applied to assess the associated factors for significant liver inflammation (G≥2) and significant fibrosis (S≥2). Results: Among the 873 CHB patients, hepatic steatosis was prevalent in 255 patients (29.21%). Significant liver inflammation was present in 461 patients (52.81%), while significant fibrosis was observed in 527 patients (60.37%). Fatty liver was an independent risk factor for significant liver inflammation (OR: 2.117, 95% CI: 1.500-2.988), but it could not predict significant fibrosis. We developed a predictive model for significant liver inflammation with the area under receiver operating characteristic curve (AUROC) of 0.825, and a model for significant fibrosis with the AUROC of 0.760.Conclusions: NAFLD is independently associated with significant liver inflammation, but does not increase the fibrosis severity.