Evaluation of hepatosteatosis in patients with chronic hepatitis B virus infection

Arab Journal of Gastroenterology

Available online 7 June 2022

Arab Journal of GastroenterologyAbstractBackground and study aims

The current study aimed to investigate the frequency of hepatic steatosis in chronic hepatitis B (CHB) patients and determine the possible risk factors associated with its presence.

Patients and methods

This cross-sectional study retrospectively evaluated the medical records of 255 adult CHB patients visiting an infectious disease outpatient clinic. Patients with hepatitis B surface antigen positivity for >6 months and those who did not receive antiviral therapy were included in the study. The presence and stage of hepatic steatosis were determined through hepatobiliary ultrasonography.

Results

The mean age of the patients was 40.6 ± 12.7 years. Hepatic steatosis was detected in 44.4 % of the patients through ultrasound imaging. Our findings showed that the detected steatosis prevalence in our patients with CHB was significantly higher compared to the highest prevalence of non-alcoholic steatohepatitis found in the general Turkish population (19.9 %) [RR 2.23 (1.75–2.86), p < 0.001]. CHB patients with steatosis had significantly higher age, triglyceride, and gamma-glutamyl transferase levels than those without steatosis (p < 0.05). No significant association was found between the presence of steatosis, sex, liver function test results, and platelet, alkaline phosphatase, cholesterol, alpha fetoprotein, or HBV-DNA levels. No significant relationship was found between aspartate aminotransferase (AST)/platelet ratio index (APRI) and steatosis was examined (p > 0.05). Post-hoc analysis showed a significant relationship between HBV-DNA levels and ALT, AST, and APRI scores.

Conclusion

Our data showed that hepatic steatosis is more common in CHB patients than in the general population. Older age and high triglyceride levels increased the risk of hepatic steatosis in CHB patients, consequently increasing GGT levels, which are indicative of liver damage, in these patients.

Introduction

Despite the availability of an effective vaccine, Hepatitis B virus (HBV) remains a serious public health problem, causing approximately 257 million chronic hepatitis B (CHB) infections worldwide [1]. Turkey is considered a mid-endemic country for HBV infections, with a prevalence rate of 2%–8% [2]. Non-Alcoholic Fatty Liver Disease (NAFLD), the global prevalence of which is 25 %, can be characterized as the accumulation of triglycerides (TG) within hepatocytes exceeding 5 % of the liver weight [3]. Together with the increasing rates of obesity and metabolic syndrome, NAFLD has become one of the most important causes of chronic liver disease worldwide [4]. Analysis of studies examining the presence of NAFL in healthy general Turkish population found a prevalence ranging from 10.6 % to 19.8 % [[5], [6]]. Both CHB and NAFL are important causes of liver-related morbidity and mortality, with both diseases increasing the risk of cirrhosis and hepatocellular cancer [4]. Liver biopsy remains the gold standard in evaluating liver damage due to viral causes or NAFL, although liver damage can also be evaluated using noninvasive modalities, such as ultrasonographic techniques and serum markers [7]. The current study aimed to determine the relationship between hepatosteatosis and biochemical and viral parameters by thoroughly examining the frequency of hepatosteatosis in patients with CHB infection.

Section snippetsPatients and methods

This cross-sectional study evaluated 255 adult CHB patients who were followed up at our hospital's infectious diseases outpatient clinic between June 2019 and December 2019. Patients with positive hepatitis B surface antigen (HBsAg) for >6 months and those who did not receive antiviral therapy were included in the study. Demographic, clinical, and laboratory data of the patients were obtained from the electronic system of the hospital.

Pregnant women, patients under the age of 18, those using

Results

Patients included in the study had a mean age of 40.6 ± 12.7 years, 42 % of whom were women. Hepatitis B e antigen (HBeAg) and HBe antibody (anti-HBe) positivity among the included patients are shown in Fig. 1. HBV-DNA polymerase chain reaction test showed detected levels to be <2.000 IU/mL in 72.9 % of the patients. Hepatobiliary USG examination data were available in 214/255 patients (83.9 %). Our findings showed that 44.4 % of the 214 CHB patients who underwent ultrasonographic examination

Discussion

Hepatitis B is a hepatotropic virus that, when present chronically, can lead to cirrhosis, liver failure, and hepatocellular carcinoma [9]. In addition, HBV infection causes metabolic disorders by interfering with hepatic metabolic signaling pathways, including glucose, lipid, nucleic acid, bile acid, and vitamin metabolism in the liver [10]. There have been varying opinions regarding the effect of HBV on the development of hepatosteatosis. One study suggested that HBV X protein causes lipid

Ethics committee approval

The study was approved by regional ethics committee. (Decision No: 2020/17, Date: 03/09/2020).

Author contribution

Concept: M.S.S., A.A., D.B., Design: M.S.S, A.A., Data Collection and/or Processing: M.S.S., D.B., Analysis and/or Interpretation: A.A., Literature Search: M.S.S., D.B., Writing: M.S.S., A.A. Critical Reviews: A.A.

Financial Disclosure

The authors declared that this study has received no financial support.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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© 2022 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

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