Non-invasive Assessment of Advanced Fibrosis and Steatosis in Chronic Hepatitis B Patients with Comorbid NAFLD

Abstract

Background: The co-occurrence of chronic Hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) has become increasingly prevalent in clinical practice. However, reliable non-invasive serological markers that can accurately diagnose hepatic fibrosis and steatosis in patients affected by these dual etiologies remain deficient. Methods: A cross-sectional study was performed on 99 CHB + NAFLD patients who underwent liver biopsy. Based on histopathological findings, patients were categorized into S ≥ 3 and S ≤ 2 groups for fibrosis and F ≥ 2 and F < 2 groups for steatosis. Correlation analysis was conducted using Spearman’s method. The diagnostic efficacy of relevant indicators for advanced fibrosis and steatosis was evaluated by receiver operating characteristic (ROC) curves, and the performance of different ROC curves was further compared via the DeLong test. Results: Data analysis at baseline showed that the mean age of all patients was 37.10 years, and 87.9% (87 of 99) were male. Patients with inflammation grade ≤ 2, steatosis grade ≥ 2, fibrosis stage ≥ 3, and normal ALT levels were about 99.0% (98 of 99), 30.3% (30 of 99), 36.4% (36 of 99), and 25.3% (25 of 99), respectively. Comparative analysis revealed that the S ≥ 3 group showed significantly higher age, AFP, FIB-4, and Forns Index levels compared to the S ≤ 2 group, while UA levels were significantly lower (all P < 0.05). In patients with CHB + NAFLD, fibrosis staging demonstrated significant positive correlations with age, AFP, FIB-4, and Forns Index, while showing an inverse association with UA levels (all P < 0.05). Moreover, steatosis grading was positively associated with WBC and GLU, but negatively correlated with LN (all P < 0.05). Conclusions: AUAWPGHL was the optimal biomarker for detecting advanced fibrosis (S ≥ 3), while WGLMAAH demonstrated superior performance in ruling out significant steatosis (F ≥ 2) in CHB + NAFLD patients.