Impact of Cardiometabolic Risk Factors and Steatotic Liver Disease on Liver‐Related Outcomes in Patients With Chronic Hepatitis C After Curative Antiviral Therapy

ABSTRACT Patients with chronic hepatitis C (CHC) frequently present with steatotic liver disease (SLD) and cardiometabolic risk factors (CMRFs). This study aimed to evaluate the impact of SLD and CMRFs on liver‐related outcomes (LROs) in CHC patients after HCV eradication. This study evaluated 21,972 CHC patients who received curative antivirals in Taiwan. LROs included newly developed hepatocellular carcinoma and liver decompensation. During a follow‐up period of 71,000 person‐years (PYs), 745 (3.4%) patients developed LROs (annual incidence of 1.05%). The annual incidence of LRO (136.2 vs. 80.7 per 10,000 PYs, p < 0.001) was significantly higher in patients without SLD than in those with SLD. Cox regression analysis revealed that SLD was independently associated with a lower risk of LRO (adjusted hazard ratio [aHR]/95% confidence intervals [CI]: 0.85/0.73–0.99, p = 0.038). There was an increased trend toward increased LRO risk in patients with a higher number of CMRFs than in those without CMRFs (aHR/CI: 1.35/1.02–1.78, 1.48/1.11–1.97, and 1.53/1.15–2.05 for 1, 2, and > 3 CMRFs, respectively). Non‐SLD patients who carried CMRFs were independently associated with a high risk of LROs compared to SLD patients without any CMRF carriage (aHR/CI: 1.97/1.11–3.50, p = 0.02). We concluded that CMRF burden had a dose‐dependent effect on LRO risk in CHC patients after curative antivirals. Non‐SLD CHC patients who possessed CMRFs were at a greater risk of LROs.