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

Wong, G. L.-H.; Wong, V. W.-S.; Choi, P. C.-L.; Chan, A. W.-H.; Chim, A. M.-L.; Yiu, K. K.-L.; Chan, H.-Y.; Chan, F. K.-L.; Sung, J. J.-Y.; Chan, H. L.-Y.
January 2009
Gut;Jan2009, Vol. 58 Issue 1, p111
Academic Journal
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 111%, 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 virologi- cal factors, metabolic syndrome remained an independent factor associated with probable cirrhosis (odds ratio 1.7, 95% confidence interval (Cl) 1.1 to 2.6). The odds ratios of probable cirrhosis were 1.4 (95% Cl, 0.9 to 2.3), 2.6 (95% Cl, 1.7 to 4.3), 4.1 (95% Cl, 2.4 to 7.1), 4.0 (95% Cl, 1.9 to 8.4) and 5.5 (95% Cl, 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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