Pretreatment gamma-glutamyl transferase predicts mortality in patients with chronic hepatitis B treated with nucleotide/nucleoside analogs. The Kaohsiung journal of medical sciences Jang, T., Liang, P., Jun, D. W., Jung, J. H., Toyoda, H., Wang, C., Yuen, M., Cheung, K. S., Yasuda, S., Kim, S. E., Yoon, E. L., An, J., Enomoto, M., Kozuka, R., Chuma, M., Nozaki, A., Ishikawa, T., Watanabe, T., Atsukawa, M., Arai, T., Hayama, K., Ishigami, M., Cho, Y. K., Ogawa, E., Kim, H. S., Shim, J., Uojima, H., Jeong, S. W., Ahn, S. B., Takaguchi, K., Senoh, T., Buti, M., Vargas-Accarino, E., Abe, H., Takahashi, H., Inoue, K., Huang, J., Chuang, W., Yeh, M., Dai, C., Huang, C., Nguyen, M. H., Yu, M. 2023


Elevated serum gamma-glutamyl transferase (GGT) levels are associated with chronic hepatitis B (CHB)-related hepatocellular carcinoma. However, their role in predicting mortality 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 6months (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. 67.4U/L, p=0.002) and Month-6-GGT levels (62.1 vs. 38.4U/L, p<0.001). The factors associated with all-cause mortality included cirrhosis (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 aminotransferase 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 included cirrhosis (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 independently 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 pretreatment GGT levels was observed with respect to the all-cause mortality (trend p<0.001). Pretreatment serum GGT levels predicted all-cause, liver-related, and non-liver-related mortality in patients with CHB treated with NAs.

View details for DOI 10.1002/kjm2.12771

View details for PubMedID 37885338