Air Pollution Associated With Mortality Among Chronic Hepatitis B Patients Treated With Nucleotide/Nucleoside Analogues

• Published in: Alimentary pharmacology & therapeutics Vol. 61; no. 9; pp. 1458 - 1466
• Main Authors: Jang, Tyng‐Yuan, Zeng, Yu‐Ting, Liang, Po‐Cheng, Wu, Chih‐Da, Wei, Yu‐Ju, Tsai, Pei‐Chien, Hsieh, Ming‐Yen, Lin, Yi‐Hung, Hsieh, Meng‐Hsuan, Wang, Chih‐Wen, Yang, Jeng‐Fu, Yeh, Ming‐Lun, Huang, Chung‐Feng, Chuang, Wan‐Long, Huang, Jee‐Fu, Cheng, Ya‐Yun, Dai, Chia‐Yen, Chen, Pau‐Chung, Yu, Ming‐Lung
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2025
• Subjects: Adult; Aged; Air Pollutants - adverse effects; Air pollution; Air Pollution - adverse effects; Antiviral Agents - therapeutic use; Cirrhosis; Female; Fibrosis; HBV; Hepatitis B; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - mortality; Humans; Incidence; Liver cirrhosis; Liver Cirrhosis - mortality; Liver diseases; Male; Middle Aged; Mortality; NAs; NOx; Nucleoside analogs; Nucleosides - therapeutic use; Nucleotide analogs; Risk Factors; mortality; NAs; air pollution; HBV; NOx
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.70019

ABSTRACT Background and Aims Air pollution is associated with advanced liver fibrosis in patients with chronic liver diseases, including chronic hepatitis B (CHB). This study aimed to investigate the association between air pollution and mortality in patients with CHB treated with nucleotide/nucleoside analogues. Methods We enrolled 697 patients with CHB treated with nucleotide/nucleoside analogues and analysed the incidence and risk factors for mortality. Daily air pollutant concentrations were estimated from the year before enrolment. Results All‐cause mortality showed an annual incidence of 1.1/100 person‐years after a follow‐up period of 3798.1 person‐years. Factors with the strongest association with all‐cause mortality were liver cirrhosis (hazard ratio [HR]/95% confidence interval [CI]: 3.95/1.69–9.23; p = 0.02), age ([HR]/CI: 1.07/1.03–1.17, p < 0.001) and pre‐treatment gamma‐glutamyl transferase (GGT) levels (HR/CI: 1.004/1.001–1.006, p = 0.004). Among patients with cirrhosis, the factors associated with all‐cause mortality were age (HR/CI: 1.08/1.04–1.12, p < 0.001), pre‐treatment GGT levels (HR/CI: 1.004/1.001–1.008, p = 0.01), platelet count (HR/CI: 0.988/0.977–0.998, p = 0.02) and NOx concentration (per unit increment, ppb) (1.045/1.001–1.091; p = 0.046). The best NOx cut‐off value for predicting all‐cause mortality in patients with cirrhosis was 25.5 ppb (AUROC 0.63; p = 0.03). NOx levels > 25.5 ppb were associated with a higher incidence of mortality in patients with cirrhosis (HR/CI:2.49/1.03–6.02; p = 0.04). Conclusions Air pollution influences all‐cause mortality in patients with CHB receiving nucleotide/nucleoside analogue therapy. Long‐term NOx exposure may increase liver‐related mortality in patients with chronic hepatitis B and cirrhosis receiving nucleotide/nucleoside analogue treatment. In this study, we observed an annual mortality incidence of 1.1% among patients with CHB receiving NA therapy. Long‐term NOx exposure may increase the all‐cause mortality in patients with cirrhosis. Patients with cirrhosis living in environments with high NOx levels had a 2.5‐fold higher risk of mortality than those living in environments with low NOx levels.