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. 2025 Jul;83(1):43-51.
doi: 10.1016/j.jhep.2024.12.009. Epub 2024 Dec 14.

All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease

Shang-Chin Huang  1 , Tung-Hung Su  2 , Tai-Chung Tseng  3 , Shih-Jer Hsu  4 , Chun-Ming Hong  5 , Ting-Yuan Lan  6 , Chen-Hua Liu  4 , Hung-Chih Yang  4 , Chun-Jen Liu  7 , Jia-Horng Kao  7
Affiliations

All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease

Shang-Chin Huang et al. J Hepatol. 2025 Jul.

Abstract

Background & aims: Steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB). However, the effects of metabolic dysfunction-associated SLD (MASLD) on the long-term survival of such patients remain unknown. Accordingly, this study investigated the mortality risks in patients with CHB and concurrent SLD.

Methods: Consecutive patients with CHB and concurrent SLD were retrospectively recruited at National Taiwan University Hospital. MASLD was defined by the presence of cardiometabolic risk factors. The cumulative incidences of all-cause and cause-specific mortality were compared.

Results: A total of 8,718 patients with CHB and concurrent SLD were included from 2006 to 2021. At baseline, the MASLD group (n = 6,562) was older and had a lower proportion of HBeAg positivity and lower HBV DNA levels compared with the non-MASLD group (n = 2,156). After a median follow-up period of 9.1 years, the MASLD group exhibited a higher risk of all-cause mortality compared with the non-MASLD group (adjusted hazard ratio 1.79, 95% CI 1.24-2.58, p = 0.002). Furthermore, cumulative cardiometabolic risk factors dose-dependently elevated the risks of all-cause, liver-related, and cardiovascular mortality (all p <0.05). During the follow-up period, new-onset diabetes mellitus, hypertension, and significant weight gain further increased the risks of all-cause and liver-related mortality (all p <0.05). However, patients with SLD had a lower mortality risk than those without SLD after propensity score matching (hazard ratio 0.62, 95% CI 0.53-0.74, p <0.001).

Conclusions: Among patients with CHB and SLD, metabolic burden dose-dependently increases all-cause, liver-related, and cardiovascular mortality risks. Patients with SLD have a lower mortality risk than those without SLD. Identifying these metabolic dysfunctions is crucial for stratifying the level of risk in daily care.

Impact and implications: Concurrent steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB); however, the effects of the associated cardiometabolic risk factors on all-cause and cause-specific mortality remain unknown. This study demonstrated that cumulative metabolic burden dose-dependently increased the risks of all-cause, liver-related, and cardiovascular mortality in patients with CHB and SLD. Moreover, new-onset diabetes mellitus, hypertension, and weight gain during the follow-up period further exacerbated these risks. However, patients with SLD had a lower risk of mortality than those without SLD. Thus, routine screening and monitoring of metabolic dysfunctions constitute a key element of daily care for patients with CHB.

Keywords: Diabetes mellitus; Hepatitis B virus (HBV); MASLD; fatty liver; metabolic syndrome.

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Conflict of interest statement

Conflict of interest S.-C. H. was on speaker’s bureau for Gilead Sciences. T.-H. S. received a research grant from Gilead Sciences, served as a consultant for Gilead Sciences, and was on speaker’s bureaus for Abbvie, Bayer, Bristol-Myers Squibb, Gilead Sciences, Lilly, Merck Sharp and Dohme, Roche, Sysmex and Takeda. J.-H. K. has served as a consultant for Abbvie, Abbott, Gilead Sciences, Roche, and Sysmex and on speaker’s bureaus for Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp and Dohme, and Sysmex. Others declare no conflict of interest. Please refer to the accompanying ICMJE disclosure forms for further details.

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