HBV infection, liver enzymes and their association with adverse liver disease and all-cause death: a matched retrospective cohort study in Eastern China.

backgroundChina has historically been a high-prevalence area for hepatitis B virus (HBV) infection, leading to a high incidence of adverse liver diseases and significant disease burden. However, comprehensive data on HBV infection and associated adverse liver diseases in the Chinese population remain limited. This study aimed to analyse the risk factors for adverse liver outcomes in patients who tested positive for hepatitis B surface antigen (HBsAg).

methodA matched retrospective cohort study was conducted from 1 January to 30 September 2013 in Jiangshan and Shiqi towns in Yinzhou District, Ningbo, Zhejiang Province. Data were sourced from the Yinzhou Health Information System. HBsAg-positive patients were matched 1:2 by birth year, sex, town and calendar period with HBsAg-negative controls. Adverse liver diseases, including cirrhosis, liver cancer and liver failure, were identified as outcomes, with follow-up continuing until 31 December 2022. Cox proportional hazards models were used to assess the associations between HBV infection and the risks of adverse liver disease and all-cause mortality, adjusting for age, sex, education, location, tobacco use, alcohol consumption and physical activity.

resultsA total of 1, 454 HBsAg-positive patients and 2, 766 matched controls were included, with 29, 945 person-years of follow-up (median: 9.17 years). During follow-up, 99 participants developed adverse liver diseases and 73 died. Among HBsAg-positive individuals, the incidence rate of adverse liver disease was 8.21 (95% CI: 6.59 to 10.12) per 1000 person-years, with a 12.24-fold higher risk than HBsAg-negative individuals (95% CI: 6.74 to 22.21). The mortality rate was 3.91 (95% CI: 2.84 to 5.25) per 1, 000 person-years in HBsAg-positive patients, with a 2.28-fold higher risk of all-cause mortality compared with the HBsAg-negative group (95% CI: 1.35 to 3.85). Elevated alanine aminotransferase (ALT) levels were associated with higher risks of adverse liver disease (Model 1 HR: 2.48, 95% CI: 1.49 to 4.12; Model 2 HR: 2.46, 95% CI: 1.48 to 4.12) and all-cause mortality (Model 1 HR: 3.14, 95% CI: 1.50 to 6.60; Model 2 HR: 2.77, 95% CI: 1.29 to 5.92).

conclusionThis study established a population-based cohort in eastern China using a big data platform for longitudinal follow-up. Our findings indicate that HBsAg-positive individuals face an increased risk of adverse liver outcomes and all-cause mortality, with elevated ALT serving as a significant risk marker. Enhanced HBV screening among the general population and increased ALT monitoring frequency in HBsAg-positive individuals are recommended.