Impact of comorbidities on the severity of chronic hepatitis B at presentation

Table 1 Comparison of baseline features of hepatitis B surface antigen positive patients, according to different cofactors (mean ± SD) n (%)

Variable	HBsAg positive(n = 924)	HBsAg/anti-HDV positive (n = 59)	HBsAg/anti-HCV positive (n = 130)	HBsAg/anti-HIV positive (n = 6)	HBsAg/alcohol abuse (n = 138)	HBsAg/two or more cofactors (n = 109)	P value
Age (yr)	48.4 ± 14.0	46.5 ± 11.7	55.2 ± 14.7	37.0 ± 3.6	52.7 ± 11.7	45.8 ± 12.1	< 0.001
Males	606 (66.5)	41 (71.9)	87 (68.0)	6 (100)	126 (92.6)	92 (86.8)	< 0.001
In-patients	171 (18.9)	15 (25.4)	29 (22.7)	0	20 (14.7)	30 (28.0)	0.060
Out-patients	732 (81.1)	44 (74.6)	99 (77.3)	6 (100)	116 (85.3)	77 (72.0)
Prevalent cases	769 (83.2)	53 (89.8)	111 (85.4)	6 (100)	115 (83.3)	95 (87.2)	0.500
Incident cases	155 (16.8)	6 (10.2)	19 (14.6)	0	23 (16.7)	14 (12.8)
Born in Italy
North	192 (21.0)	11 (18.6)	36 (27.7)	3 (50.0)	32 (23.7)	35 (32.4)	0.010
Centre	195 (21.3)	5 (8.5)	16 (12.3)	0	26 (19.3)	21 (19.4)
South/islands	484 (52.9)	40 (67.8)	76 (58.5)	2 (33.3)	73 (54.1)	49 (45.4)
Born Abroad	44 (4.8)	3 (5.1)	2 (1.5)	1 (16.7)	4 (2.9)	3 (2.8)
Asymptomatic carrier	233 (33.5)	3 (6.0)	17 (17.7)	1 (100)	19 (17.6)	5 (6.0)	< 0.001
Chronic hepatitis1	313 (45.0)	25 (50.0)	41 (42.7)	0	39 (36.1)	35 (42.2)
Liver cirrhosis	115 (16.5)	22 (44.0)	30 (31.3)	0	43 (39.8)	39 (47.0)
HCC	34 (4.9)	0	8 (8.3)	0	7 (6.5)	4 (4.8)
ALT (× ULN) (median, IQR)	1.0 (1.0-1.8)	2.2 (1.1-4.8)	1.4 (1.0-2.1)	1.5 (1.1-1.8)	1.1 (1.0-2.1)	1.8 (1.0-2.9)	< 0.001
BMI (kg/m2)	25.0 ± 3.4	25.5 ± 5.0	24.8 ± 3.1	22.8 ± 2.0	26.1 ± 3.5	25.6 ± 4.1	0.006
Years of schooling							< 0.001
< 6	239 (26.3)	9 (16.4)	46 (36.5)	1 (16.7)	62 (46.3)	31 (28.7)
6-13	369 (40.7)	31 (56.4)	53 (42.1)	1 (16.7)	53 (39.5)	60 (55.6)
> 13	299 (33.0)	15 (27.2)	27 (21.4)	4 (66.6)	19 (14.2)	17 (15.7)
HBeAg positive	116 (12.6)	9 (15.3)	10 (7.7)	4 (66.7)	10 (7.2)	15 (13.8)	< 0.001
HBeAg negative	808 (87.4)	50 (84.7)	120 (92.3)	2 (33.3)	128 (92.8)	94 (86.2)

¹Only subjects with liver biopsy. HBsAg: Hepatitis B surface antigen; HDV: Hepatitis D virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; HCC: Hepatocellular carcinoma; ALT: Alanine aminotransferase; × ULN: Times the upper limit of the normal; IQR: Interquartile range; BMI: Body mass index; HBeAg: Hepatitis B e antigen.

Table 2 Risk factors associated with cirrhosis in hepatitis B surface antigen positive patients n (%)

Variable	Chronic hepatitis	Cirrhosis	Crude OR (95% CI)	Adjusted OR (95% CI)	P value
Age (mean ± SD, yr)	44.9 ± 12.0	56.2 ± 11.6	1.06 (1.05-1.07)	1.10 (1.08-1.11)	< 0.001
Gender
Male	371 (81.9)	192 (77.1)	1
Female	82 (18.1)	57 (22.9)	1.34 (0.92-1.97)
HBeAg
Negative	387 (85.4)	225 (90.4)	1
Positive	66 (14.6)	24 (9.6)	0.63 (0.38-1.03)
Anti-HCV
Negative	382 (84.3)	187 (75.1)	1	1	0.300
Positive	71 (15.7)	62 (24.9)	1.78 (1.22-2.62)	1.23 (0.84-1.80)
HCV-RNA
Negative	382 (86.2)	187 (77.3)	1	1	0.200
Positive	61 (13.8)	55 (22.7)	1.84 (1.23-2.76)	1.44 (0.65-1.72)
Anti-HDV
Negative	410 (90.5)	207 (83.1)	1	1	< 0.001
Positive	43 (9.5)	42 (16.9)	1.94 (1.23-3.06)	2.68 (1.56-4.61)
Anti-HIV
Negative	449 (99.1)	241 (96.8)	1	1	0.010
Positive	4 (0.9)	8 (3.2)	3.73 (1.11-12.50)	5.78 (1.50-22.27)
Alcohol (drinks/d)
0	247 (54.5)	117 (47.0)	1	1
< 4	143 (31.6)	56 (22.4)	0.83 (0.57-1.21)	0.69 (0.48-1.07)	0.080
4-8	35 (7.7)	37 (14.9)	2.23 (1.34-3.72)	2.30 (1.29-4.01)	0.005
> 8	28 (6.2)	39 (15.7)	2.94 (1.73-5.01)	2.42 (1.31-4.46)	0.005
BMI (kg/m2)
< 25	247 (54.5)	121 (48.6)	1
25-30	173 (38.2)	107 (43.0)	1.26 (0.91-1.75)
> 30	33 (7.3)	21 (8.4)	1.30 (0.72-2.34)

Crude and adjusted odds ratios (OR) deriving from multiple logistic regression analysis. Patients with HCC were excluded from the analysis. HCC: Hepatocellular carcinoma; HDV: Hepatitis D virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; BMI: Body mass index.

Table 3 Percentages of cases in different child-pugh classes in 229 of the 249 patients with liver cirrhosis, by aetiology n (%)

Child-pugh class	CF group (n = 104)	HBV/alcohol group (n = 43)	HBV/HDV group (n = 19)	HBV/HCV group (n = 30)	HBV/ two or more cofactors group (n = 33)
A	71 (68.3)	24 (55.8)	13 (68.4)	17 (56.7)	8 (24.2)
B + C	33 (31.7)b	19 (44.2)	6 (31.6)	13 (43.3)	25 (75.8)b

^bP < 0.001 vs hepatitis B virus (HBV)/two or more cofactors. Patients with hepatocellular carcinoma are not included. CF: Cofactor-free; HCV: Hepatitis C virus; HDV: Hepatitis D virus.