Impact Of Metabolic Risk Factors On Liver-related Events In Patients With Chronic Hepatitis B: A Systematic Review And Meta-analysis

Background and Purpose: Approximately one-third of patients with chronic hepatitis B develop advanced liver disease,which imposes a heavy economic burden on the patient’s family and society.Metabolic risk factors,such as obesity,diabetes,and hypertension,can put patients with chronic hepatitis B at increased risk of adverse outcomes.This study aimed to assess the impact of metabolic risk factors on liver-related events(including liver cirrhosis and its complications,hepatocellular carcinoma,and liver-related death)in patients with chronic hepatitis B.Methods: This study performed a systematic review and meta-analysis of population-based cohort studies.Pub Med,Embase,Web of Science,and Cochrane library databases were systematically searched from inception to November 13,2022.Studies reporting the risk of liver-related events in adults with chronic hepatitis B with metabolic risk factors compared with adults without metabolic risk factors were included.The risk of bias was assessed using the quality in prognosis studies.Unadjusted and adjusted hazard ratios(HR)and 95% confidence intervals(CI)were pooled using random effects models.Sensitivity analyses,subgroup analyses,and publication bias assessments were also performed.Results: A total of 4435 documents were retrieved and 34 studies were screened,including 28 cohorts with a total study population of more than 520,000.Among patients with chronic hepatitis B,diabetes(adjusted HR: 1.42,95% CI: 1.23-1.63)and metabolic syndrome(adjusted HR: 3.18,95% CI: 1.53-6.64)were significantly associated with the occurrence of liver-related events;hypertension(adjusted HR:1.15,95% CI: 1.02-1.30)and obesity(adjusted HR: 1.15,95% CI: 1.04-1.28)were less associated with the occurrence of liver-related events.Subgroup analyses showed that diabetes was associated with an increased risk of hepatocellular carcinoma and liver-related death in patients with chronic hepatitis B,with pooled adjusted HRs of1.38(95% CI: 1.16-1.64)and 1.55(95% CI: 1.14-2.11)respectively;metabolic syndrome was significantly associated with the development of hepatocellular carcinoma in patients with chronic hepatitis B(adjusted HR: 2.85,95% CI.1.64-4.95).Conclusion: Patients with chronic hepatitis B in combination with diabetes and metabolic syndrome are at significantly increased risk for liver-related events in the future,especially hepatocellular carcinoma.Patients with chronic hepatitis B should implement a comprehensive treatment approach including lifestyle changes,weight loss,and pharmacological interventions targeting metabolic disorders to prevent liver disease progression.