Evaluation of the impact of Hepatitis B markers on liver fibrosis using different scoring systems in patients with MASLD

Introduction: Fatty liver disease and chronic hepatitis B (HBV) infection have been defined as independent risk factors for liver fibrosis. However, the impact of the coexistence of these two pathologies on fibrosis progression remains unclear, and findings in the literature are conflicting. The aim of this study was to comparatively evaluate liver fibrosis among different hepatitis B serological groups, categorized based on prior HBV exposure, using non-invasive fibrosis scoring systems in individuals with hepatic steatosis. Materials and Methods: This retrospective study included 286 patients diagnosed with hepatic steatosis, who were divided into four groups based on HBV serological markers: individuals with no prior exposure to HBV, HBsAg-positive carriers, those with resolved infection (anti-HBs and anti-HBc positive), and those with isolated anti-HBc positivity. Demographic, clinical, and biochemical data were collected, FIB-4, APRI, GPR, and NAFLD Fibrosis Score (NFS) were calculated for each patient. Fibrosis scores were compared between groups. Results: Fibrosis scores showed statistically significant differences between the groups. FIB-4 and NFS scores were highest in the isolated anti-HBc positive group, whereas APRI and GPR scores were highest in the HBsAg carrier group (p<0.01). Lower fibrosis levels were observed in individuals who had never been exposed to HBV and in those with resolved (immune) HBV infection. In correlation analyses a moderate-to-strong correlation was found between FIB-4 and both APRI and NFS scores (r = 0.62–0.74), while a moderate-to-weak correlation was observed between FIB-4 and GPR (r = 0.24–0.54). Conclusion: Hepatitis B carriage and occult HBV infection may increase the risk of fibrosis in patients with fatty liver, and a more careful clinical approach may be necessary in these patient groups. The combined use of non-invasive scores can support clinical decision-making. Further studies confirming the findings with gold standard methods such as liver biopsy are needed. Keywords: Steatotic liver disease, Hepatitis B virus, Liver fibrosis