# Association between fatty liver and risk of liver failure in patients with acute hepatitis B: a retrospective cohort study

## TL;DR

Fatty liver increases the risk of liver failure in patients with acute hepatitis B, according to a study of 200 hospitalized patients.

## Contribution

This study identifies fatty liver as an independent risk factor for acute liver failure in acute hepatitis B patients.

## Key findings

- Fatty liver was associated with a 4.61-fold higher risk of acute liver failure in acute hepatitis B patients.
- The association between fatty liver and liver failure was stronger in rural patients.
- Fatty liver did not significantly affect HBsAg loss or seroconversion rates.

## Abstract

Fatty liver (FL) is a common comorbidity that has been associated with adverse clinical outcomes in various liver diseases. However, its impact on the prognosis of acute hepatitis B (AHB) remains unclear. This study aimed to evaluate the influence of FL on liver-related outcomes among hospitalized patients with AHB.

A retrospective analysis was conducted on hospitalized patients diagnosed with AHB from January 1, 2010, to December 30, 2023. Demographic and clinical data were collected, and patients were categorized into AHB with FL (AHB-FL) and AHB without FL (AHB-no FL) groups based on imaging and laboratory examinations. Multivariate regression models were utilized to investigate the association between FL and liver-related outcomes, including acute liver failure (ALF), hepatitis B surface antigen (HBsAg) loss, and seroconversion. Kaplan-Meier analysis was performed to assess differences in time to HBsAg loss and seroconversion.

A total of 200 eligible patients were included, with 29 (14.5%) in the AHB-FL group and 171 (85.5%) in the AHB-no FL group. The incidence of ALF was significantly higher in the AHB-FL group (34.5% vs. 15.8%, P = 0.02). No significant differences were observed in rates of HBsAg loss (75.9% vs. 82.5%, P = 0.40) or seroconversion (44.4% vs. 53.1%, P = 0.40) between the two groups. Kaplan-Meier analysis indicated comparable times to HBsAg loss (P = 0.07) and seroconversion (P = 0.43). Multivariable analysis confirmed FL as an independent risk factor for ALF (OR 4.61, 95% CI 1.26–16.86; P = 0.02), but not for HBsAg loss (HR 1.60, 95% CI 0.92–2.78; P = 0.10) or seroconversion (HR 1.69, 95% CI 0.80–3.57; P = 0.17). Subgroup analysis indicated a stronger association between FL and ALF in rural patients (P interaction=0.02), suggesting regional differences may affect clinical risks and management.

FL constitutes a robust and independent determinant of ALF in AHB patients, sustained after rigorous adjustment for confounding factors. This evidence highlights a specific metabolic aggravation of liver injury, mandating the integration of FL screening into early risk stratification and management protocols.

Cohort graphic showing 200 acute hepatitis B patients: 48.5% male, mean age 32, 64.5% married, 59.5% rural, 14.5% with pre-existing fatty liver. Outcomes compared between those with fatty liver (N=29) and without (N=171). Significant association found between fatty liver and acute liver failure (34.5% vs. 15.8%, OR=4.61, P=0.02). No significant association for HBsAg loss (75.9% vs. 82.5%, HR=1.60, P=0.10) or HBsAg seroconversion (44.4% vs. 53.1%, HR=1.69, P=0.17). Icons represent hepatitis B, hazard ratio, and odds ratio.