Hepatology

Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B

G L-H Wong^1,2, V W-S Wong^1,2, P C-L Choi³, A W-H Chan³, A M-L Chim^1,2, K K-L Yiu^1,2, H-Y Chan^1,2, F K-L Chan^1,2, J J-Y Sung^1,2, H L-Y Chan^1,2

¹ Institute of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China
² Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Hong Kong SAR, China
³ Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China

Dr H L Y Chan, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China; hlychan{at}cuhk.edu.hk

Background: Metabolic syndrome is associated with non-alcoholic steatohepatitis and cryptogenic cirrhosis. Whether metabolic syndrome affects the severity of chronic hepatitis B (CHB) is unclear.

Aim: We aimed to study the relationship between metabolic syndrome and the risk of liver cirrhosis in patients with CHB.

Methods: We prospectively recruited patients with CHB from primary care and hospital clinics for liver stiffness measurement (LSM) with transient elastography to diagnose early cirrhosis. Probable cirrhosis was defined as LSM 13.4 kPa. We analysed a subgroup of patients with paired LSM and liver biopsies to validate the accuracy of LSM.

Results: 1466 patients had reliable LSM and 134 (9%) patients had adequate liver biopsy. 188 (13%) patients had metabolic syndrome. Histological liver cirrhosis was present in 32/134 (24%) patients. Histological liver cirrhosis was more common among patients who had metabolic syndrome (38%) versus those who did not (11%, p<0.001). The specificity of probable cirrhosis on LSM for histological cirrhosis was 94%. Probable cirrhosis was present in 187 (13%) patients. Metabolic syndrome was more prevalent in patients with probable cirrhosis (24%) than those without cirrhosis (11%, p<0.001). After adjustment for anthropometric, biochemical and virological factors, metabolic syndrome remained an independent factor associated with probable cirrhosis (odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.6). The odds ratios of probable cirrhosis were 1.4 (95% CI, 0.9 to 2.3), 2.6 (95% CI, 1.7 to 4.3), 4.1 (95% CI, 2.4 to 7.1), 4.0 (95% CI, 1.9 to 8.4) and 5.5 (95% CI, 1.8 to 16.7) in patients with one, two, three, four and five components of metabolic syndrome, respectively.

Conclusion: Metabolic syndrome is an independent risk factor of liver cirrhosis in CHB.

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