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

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. [ABSTRACT FROM AUTHOR]