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CONCURRENT FATTY LIVER IS ASSOCIATED WITH HIGHER RISK OF HEPATOCELLULAR
CARCINOMA AND MORTALITY IN
PATIENTS WITH CHRONIC VIRAL HEPATITIS
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AASLD 2021 Nov 12-15
Mi Na Kim1, Kyungdo Han2, Juhwan Yoo3, Seong-Gyu Hwang1 and Sang Hoon Ahn4, (1)Department of Internal Medicine, CHA Bundang Medical Center, CHA University, (2)Soongsil University, (3)The Catholic University of Korea, (4)Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
Background: Population-based data are lacking regarding whether fatty liver is a risk factor for hepatocellular carcinoma (HCC) and mortality in patients with chronic viral hepatitis. We investigated the association of concurrent fatty liver with HCC incidence and mortality in patients with chronic viral hepatitis using a nationwide cohort.
Methods: We included 57,385 patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC) patients (48,335 with CHB and 9,050 with CHC) who underwent health examinations covered by the National Health Insurance Service of South Korea in 2009. The patients were divided into three groups: no fatty liver, fatty liver index (FLI) <30; grade 1 (G1) fatty liver, 30≤ FLI <60; and grade 2 (G2) fatty liver, FLI >60. Using Cox regression, multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated.
Results: During a median 8.4-year follow-up, we documented 3,496 HCC cases and 4,146 deaths. Compared with patients who did not have fatty liver (n = 35,018), the risk of HCC was significantly higher in patients with G1 fatty liver (n = 14,544) (aHR = 1.50, 95% CI = 1.38-1.64) and G2 fatty liver (n = 7,823) (aHR = 1.88, 95% CI = 1.67-2.12). The risk of mortality significantly increased in patients with G1 fatty liver (aHR = 1.53, 95% CI = 1.41-1.66) and G2 fatty liver (aHR = 2.16, 95% CI = 1.94-2.42) compared with patients who did not have fatty liver. Among patients with liver cirrhosis (n = 6,327), the risk of HCC and mortality significantly increased in patients with G1 fatty liver (aHR = 1.43 for HCC; aHR = 1.95 for mortality) and in patients with G2 fatty liver (aHR = 1.91 for HCC; aHR = 3.02 for mortality), compared to patients with no fatty liver (all P <0.05).
Conclusion: Concurrent fatty liver was associated with a higher risk of HCC and mortality in patients with chronic viral hepatitis. Our results suggest the importance of assessment and management of fatty liver to reduce the risk of HCC and mortality in patients with chronic viral hepatitis.
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