Coincidental metabolic syndrome increases the risk of liver fibrosis progression in patients with chronic hepatitis B - a prospective cohort study with paired transient elastography examinations

Background Metabolic syndrome is a known risk factor of cirrhosis in chronic hepatitis B (CHB). Aim To investigate the effects of coincidental metabolic syndrome on liver fibrosis progression in treatment-naive CHB patients. Methods A total of 1466 CHB patients underwent liver stiffness measurement (LSM) by transient elastography in 2006-2008; 663 patients remained treatment-naive and had second LSM in 2010-2012. Liver fibrosis progression was defined as an increase in LSM >= 30% at the second assessment. The impact of coincidental metabolic syndrome and its factors on liver fibrosis progression were evaluated after adjustment for viral load and hepatitis activity. Results At baseline, the mean age was 43 +/- 12years, 55% were males, serum alanine aminotransferase (ALT) was 44 +/- 40IU/L, HBV DNA was 4.0 +/- 2.0logIU/mL and LSM was 6.3 +/- 3.6kPa. Metabolic syndrome was diagnosed in 80 (12%) and 142 (21%) patients at baseline and follow-up visit, respectively; 84 (13%) and 22 (3%) patients had coincidental and resolved metabolic syndrome respectively. After an interval of 44 +/- 7months, 107 (16%) patients developed liver fibrosis progression. Coincidental metabolic syndrome [adjusted odds ratio (aOR) 2.0, 95% confidence interval (CI) 1.1-3.5, P=0.015], central obesity (aOR 2.0, 95% CI 1.0-4.1, P=0.05) and low level of high-density lipoprotein cholesterol (aOR 1.9, 95% CI 1.0-3.7, P=0.04) were associated with liver fibrosis progression independent of change in viral load and ALT level. The effects of coincidental metabolic syndrome were most apparent in the immune-tolerant phase. Conclusion Coincidental metabolic syndrome increases the risk of liver fibrosis progression in patients with chronic hepatitis B infection, independent of viral load and hepatitis activity.