Hepatitis B with metabolic dysfunction-associated steatotic liver disease: increased risk in mortality

• Cumulative metabolic burden aggravates the risks of all-cause, liver-related, and cardiovascular mortality in a dose-dependent manner among patients with chronic hepatitis B (CHB) and concurrent steatotic liver disease (SLD).

• New-onset diabetes mellitus, hypertension, and weight gain during the follow-up period further exacerbate the risks of mortality.

• Patients with concurrent SLD are associated with a lower risk of mortality than those without SLD, regardless of metabolic dysfunctions.

• Routine screening and the aggressive identification of metabolic dysfunctions are crucial for effective risk stratification and management of patients with CHB.

Taipei, Taiwan – A groundbreaking study from National Taiwan University Hospital has unveiled how metabolic dysfunction significantly influences the mortality risks of patients with chronic hepatitis B (CHB). The research, recently published in the prestigious Journal of Hepatology, analyzed data from over 8,000 CHB patients over a 15-year period, highlighting the crucial role of metabolic health in liver disease outcomes.

Metabolic Burden Increases Mortality Risks in CHB Patients

The study found that CHB patients with concurrent steatotic liver disease (SLD) face a complex relationship between metabolic dysfunction and long-term survival. Those with metabolic disorders—such as diabetes, hypertension, and obesity—exhibited a markedly higher risk of all-cause, liver-related, and cardiovascular mortality. Notably, a higher cumulative metabolic burden was associated with a dose-dependent increase in mortality risks.

Among the metabolic disorders examined, diabetes mellitus was the most critical factor, with poorly controlled blood glucose levels (HbA1c > 8.0%) leading to a fourfold increase in liver-related mortality compared to those with well-controlled glucose levels (HbA1c < 6.0%). Additionally, patients who developed new-onset diabetes or hypertension during the follow-up period faced an even greater risk of death, emphasizing the importance of early diagnosis and proactive metabolic management. 

"Patients with chronic hepatitis B who develop metabolic disorders are at significantly greater risk of death, especially those with multiple metabolic conditions," said Prof. Tung-Hung Su, from National Taiwan University Hospital and lead author of the study. "Our findings emphasize the urgent need for routine metabolic screening and early intervention in this population. Metabolic health is not just an ancillary concern in chronic liver disease—it plays a direct role in determining long-term patient outcomes." 

Unexpected Protective Effect of Non-Metabolic Steatotic Liver Disease

Surprisingly, the study also revealed that CHB patients with SLD but without metabolic abnormalities had a lower risk of mortality compared to those without SLD. This suggests that hepatic steatosis, in the absence of metabolic dysfunction, might have a protective effect against long-term liver-related complications. 

"This was an unexpected finding," said Dr. Shang-Chin Huang, from National Taiwan University and first author of the study. "While steatotic liver disease is generally considered a risk factor for liver-related complications, our results indicate that when it occurs without metabolic dysfunction, it might actually reduce mortality risks in CHB patients. This aligns with some of our previous research, which suggests that liver fat accumulation might, in some cases, be associated with improved clearance of hepatitis B virus." 

Clinical Implications and Recommendations

Given the strong association between metabolic dysfunction and increased mortality, the researchers emphasize the importance of regular metabolic health monitoring for CHB patients. In particular, the study found that new-onset diabetes, hypertension, and excessive weight gain during follow-up further exacerbated mortality risks. 

For patients with CHB, the study underscores the need for routine screening for metabolic dysfunction, including BMI, blood sugar, blood pressure, and lipid levels. Early intervention for those with metabolic disorders is need to prevent long-term complications. 

This study adds a new dimension to the understanding of metabolic dysfunction’s role in chronic liver disease and calls for an integrated approach in managing hepatitis B patients. The results have drawn global attention in the hepatology field, providing critical insights for future research and public health strategies. 

"Our findings have significant implications for the clinical management of hepatitis B patients," added Prof. Tung-Hung Su. "Beyond antiviral treatment, managing metabolic health should be a key component of hepatitis B care to improve patient outcomes."  

National Taiwan University and its affiliated hospitals are globally recognized as premier institutions in medical research and healthcare innovation. With a strong foundation in cutting-edge biomedical science and translational medicine, they drive advancements in understanding complex diseases, pioneering novel treatments, and shaping the future of precision medicine. Their commitment to excellence has positioned them at the forefront of hepatology, impacting patient care not only in Taiwan but across Asia and beyond.

Prof. Tung-Hung Su’s email address: [email protected]