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Impact of components of metabolic syndrome on long-term outcomes of CHB with nucleos(t)ide analogue treatment.

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Impact of components of metabolic syndrome on long-term outcomes of CHB with nucleos(t)ide analogue treatment. Clinical and molecular hepatology Huang, R., Jun, D. W., Toyoda, H., Hsu, Y. C., Trinh, H., Nozaki, A., Ishikawa, T., Watanabe, T., Uojima, H., Huang, D. Q., Honda, T., Tanaka, Y., Vutien, P., Marciano, S., Abe, H., Enomoto, M., Atsukawa, M., Takahashi, H., Tsuji, K., Takaguchi, K., Tsai, P. C., Dai, C. Y., Huang, J. F., Huang, C. F., Yeh, M. L., Yoon, E., Kim, S. E., Ahn, S. B., Kim, G. A., Jung, J. H., Jeong, S. W., Oh, H., Tseng, C. H., Ishigami, M., Chau, A., Maeda, M., Yasuda, S., Chuma, M., Ito, T., Kawashima, K., Liu, J. K., Gadano, A., Kozuka, R., Itokawa, N., Inoue, K., Senoh, T., Li, J., Chuang, W. L., Cheung, R., Wu, C., Yu, M. L., Nguyen, M. H. 2025

Abstract

Given the rise of metabolic diseases, we investigated their long-term impact in chronic hepatitis B (CHB) patients receiving nucleos(t)ide analogue (NA).We analyzed data from CHB patients who initiated NAs from 30 centers (7 countries/regions). We balanced patient characteristics with and without metabolic disease (diabetes, obesity, dyslipidemia, and hypertension) via propensity-score matching (PSM) to evaluate adverse liver events and motality.The study included 4,500 CHB patients (54.6% with =1 metabolic disease). PSM yielded 909 pairs of patients with balanced characteristics. When stratified by the number of metabolic disease, only patients with =2 metabolic diseases had increased cumulative incidence of cirrhosis and overall death (but not HCC or cause-specific death). However, when stratified by the presence of diabetes (regardless of the presence or number of other metabolic diseases), patients with diabetes (vs. those without) had significantly higher cumulative incidence of all outcomes: cirrhosis (P=0.009), HCC (P=0.023), overall, liver-related and non-liver-related death (P<0.001, P=0.026 and P<0.001, respectively). On Cox regression analysis, having =2 metabolic diseases was associated with cirrhosis, overall death and non-liver-related death but not HCC and liver-related death, while diabetes was significantly associated with higher risk of all outcomes: cirrhosis (HR=3.75, P=0.004), HCC (HR=2.02, P=0.020), overall, liver-related and non-liver-related death (HR=2.53, P<0.001; HR=2.65, P=0.016; HR=2.38, P<0.001).Having =2 metabolic diseases was associated with significantly higher risk of cirrhosis, overall death and non-liver-related death, but having diabetes as a single metabolic disease was significantly associated with all adverse outcomes including cirrhosis, HCC, overall, liver-related and non-liver-related death.

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