Background: Metabolic syndrome is associated with nonalcoholic 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 CHB patients.
Methods: We prospectively recruited CHB patients from primary care and hospital clinics for liver stiffness measurement (LSM) with transient elastography to diagnose early cirrhosis. Probable cirrhosis was defined as LSM iÝ13.4kPa. We analyzed a subgroup of patients with paired LSM and liver biopsies to validate the accuracy of LSM.
Results: One thousand four hundred and sixty-six patients had reliable LSM and 134 (9%) patients had adequate liver biopsy. One hundred and eighty-eight (13%) patients had metabolic syndrome. Histologic liver cirrhosis was present in 32/134 (24%) patients. Histologic 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 histologic 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 virologic factors, metabolic syndrome remained an independent factor associated with probable cirrhosis (odds ratio 1.7, 95% confidence interval [CI] 1.1"C2.6). The odds ratios of probable cirrhosis were 1.4 (95% CI 0.9"C2.3), 2.6 (95% CI 1.7"C4.3), 4.1 (95% CI 2.4"C7.1), 4.0 (95% CI 1.9"C8.4) and 5.5 (95% CI 1.8"C16.7) in patients with 1, 2, 3, 4 and 5 components of metabolic syndrome, respectively.
Conclusion: Metabolic syndrome is an independent risk factor of liver cirrhosis in CHB.