Pretreatment gamma‐glutamyl transferase predicts mortality in patients with chronic hepatitis B treated with nucleotide/nucleoside analogs

Abstract

<p>Elevated serum gamma-glutamyl transferase (GGT) levels are associated with chronic hepatitis B (CHB)-related hepatocellular carcinoma. However, their role in predictingmortality in patients with CHB treated with nucleotide/nucleoside analogs (NAs) remains elusive. Altogether, 2843 patients with CHB treated with NAs were recruited from a multinational cohort. Serum GGT levels before and 6 months (Month-6) after initiating NAs were measured to explore their association with all-cause, liver-related, and non-liver-related mortality. The annual incidence of all-cause mortality was 0.9/100 person-years over a follow-up period of 17,436.3 person-years. Compared with patients who survived, those who died had a significantly higher pretreatment (89.3 vs. 67.4 U/L,p=0.002) and Month-6-GGT levels (62.1vs. 38.4 U/L, p< 0.001). The factors associated with all-cause mortality included cir-rhosis (hazard ratio [HR]/95% confidence interval [CI]: 2.66/1.92–3.70,p< 0.001), pretreatment GGT levels (HR/CI: 1.004/1.003–1.006, p< 0.001), alanine aminotrans-ferase level (HR/CI: 0.996/0.994–0.998, p=0.001), and age (HR/CI: 1.06/1.04–1.07, p< 0.001). Regarding liver-related mortality, the independent factors includedcirrhosis (HR/CI: 4.36/2.79–6.89,p< 0.001), pretreatment GGT levels (HR/CI:1.006/1.004–1.008, p< 0.001), alanine aminotransferase level (HR/CI: 0.993/0.990–0.997, p=0.001), age (HR/CI: 1.03/1.01–1.05,p< 0.001), and fatty liver disease(HR/CI: 0.30/0.15–0.59,p=0.001). Pretreatment GGT levels were also indepen-dently predictive of non-liver-related mortality (HR/CI: 1.003/1.000–1.005, p=0.03). The results remained consistent after excluding the patients with a history of alcohol use. A dose-dependent manner of <25, 25–75, and >75 percentile of pre-treatment GGT levels was observed with respect to the all-cause mortality (trendp< 0.001). Pretreatment serum GGT levels predicted all-cause, liver-related, andnon-liver-related mortality in patients with CHB treated with NAs.<br></p>