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Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B.

Publication ,  Journal Article
Choi, HSJ; Brouwer, WP; Zanjir, WMR; de Man, RA; Feld, JJ; Hansen, BE; Janssen, HLA; Patel, K
Published in: Hepatology
February 2020

BACKGROUND AND AIMS: Chronic hepatitis B (CHB) and nonalcoholic fatty liver disease are increasingly observed together in clinical practice, and development of nonalcoholic steatohepatitis (NASH) represents another leading cause of liver-related morbidity and mortality. Our aims were to determine whether biopsy-proven NASH impacts clinical outcomes in CHB patients and assess prognostic risk factors. APPROACH AND RESULTS: CHB patients attending two tertiary centers in North America and Europe over 13 years with available clinical and biopsy data were included. Patients were categorized as no-NASH or probable/definite NASH based on standardized histological assessment. Clinical events (death, decompensation, transplant, and hepatoma) were evaluated, and Kaplan-Meier survival estimates and Cox proportional hazards regression were used to analyze the incidence of events. There were 1,089 CHB patients, classified as no-NASH (n = 904, 83%) or NASH (n = 185, 17%), with 52 (6%) versus 27 (15%) experiencing outcome events during follow-up, respectively. In the multivariable analysis adjusting for age, sex, hepatitis B e antigen serostatus, and diabetes, the presence of NASH and concomitant advanced fibrosis (AF) was significantly associated with clinical outcomes (hazard ratio [95% confidence interval], 4.8 [2.6-9.0], P < 0.01) when compared to absence of NASH and AF (reference). NASH and AF were associated with a greater risk of outcomes compared to AF (P = 0.01) or NASH alone (P < 0.01). Of the three histological determinants of NASH, ballooning and inflammation, but not steatosis, were independently associated with clinical outcomes (P < 0.05) in place of NASH. NASH was significantly associated with increased risk of hepatocellular carcinoma and death (P < 0.01) but not decompensation (P = 0.33). CONCLUSIONS: In our large combined tertiary center cohort, patients with concomitant NASH and CHB had more AF and shorter time to development of liver-related outcomes or death compared to patients with CHB alone. Among patients with AF, superimposed NASH predicted poorer clinical outcomes.

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Published In

Hepatology

DOI

EISSN

1527-3350

Publication Date

February 2020

Volume

71

Issue

2

Start / End Page

539 / 548

Location

United States

Related Subject Headings

  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Humans
  • Hepatitis B, Chronic
  • Gastroenterology & Hepatology
 

Citation

APA
Chicago
ICMJE
MLA
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Choi, H. S. J., Brouwer, W. P., Zanjir, W. M. R., de Man, R. A., Feld, J. J., Hansen, B. E., … Patel, K. (2020). Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B. Hepatology, 71(2), 539–548. https://doi.org/10.1002/hep.30857
Choi, Hannah S. J., Willem P. Brouwer, Wayel M. R. Zanjir, Robert A. de Man, Jordan J. Feld, Bettina E. Hansen, Harry L. A. Janssen, and Keyur Patel. “Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B.Hepatology 71, no. 2 (February 2020): 539–48. https://doi.org/10.1002/hep.30857.
Choi HSJ, Brouwer WP, Zanjir WMR, de Man RA, Feld JJ, Hansen BE, et al. Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B. Hepatology. 2020 Feb;71(2):539–48.
Choi, Hannah S. J., et al. “Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B.Hepatology, vol. 71, no. 2, Feb. 2020, pp. 539–48. Pubmed, doi:10.1002/hep.30857.
Choi HSJ, Brouwer WP, Zanjir WMR, de Man RA, Feld JJ, Hansen BE, Janssen HLA, Patel K. Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B. Hepatology. 2020 Feb;71(2):539–548.
Journal cover image

Published In

Hepatology

DOI

EISSN

1527-3350

Publication Date

February 2020

Volume

71

Issue

2

Start / End Page

539 / 548

Location

United States

Related Subject Headings

  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Humans
  • Hepatitis B, Chronic
  • Gastroenterology & Hepatology