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KMID : 1040620230290030705
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Clinical and Molecular Hepatology
2023 Volume.29 No. 3 p.705 ~ p.720
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Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis
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Yu Jun Wong
Seo Haeng-Ran
Hwai-I Yang
Jie Li
Michael Huan Le
Wan-Jung Wu
Nicole Xinrong Han
Khi Yung Fong
Elizabeth Chen
Connie Wong
Fajuan Rui
Xiaoming Xu
Lee Mi-Young
Xin Yu Hu
Choi Hee Jeong
George Boon-Bee Goh
Ramsey Cheung
Grace Wong
Vincent Wai-Sun Wong
Ming-Whei Yu
Mindie H. Nguyen
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Abstract
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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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KEYWORD
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Non-alcoholic fatty liver disease, Hepatocellular carcinoma, Mortality, HBsAg seroclearance, Fibrosis, Cirrhosis
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