Clinical characteristics of metabolic dysfunction-associated steatotic liver disease and its association with significant liver fibrosis in hospitalized patients with chronic hepatitis B: a single-center retrospective cross-sectional study

Coexistence of chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming more common in clinical settings, but the relationship between MASLD and significant liver fibrosis in CHB remains uncertain. To delineate the clinical profile of hospitalized CHB patients with concomitant MASLD and investigate the relationship of MASLD with significant liver fibrosis. A total of 776 hospitalized patients with CHB were retrospectively evaluated in this single-center cross-sectional analysis at the Public Health Clinical Center of Chengdu between December 2020 and December 2024. Using the current diagnostic criteria for MASLD, participants were assigned to either the CHB-only group or the CHB+MASLD group. Demographic data, laboratory findings, virological profiles, and FibroScan-derived liver stiffness measurements were collected. Between-group differences in clinical profiles were examined, followed by an evaluation of whether MASLD was associated with significant liver fibrosis. The analysis comprised 776 patients with CHB, including 203 (26.2%) with concomitant MASLD. Patients in the CHB+MASLD group tended to be younger and had a shorter duration of hospitalization than those in the CHB-only group. They also had higher albumin and platelet levels but lower total bilirubin, AST, and prothrombin time values. Patients with CHB+MASLD were less likely to receive antiviral treatment. Multivariable modeling provided no evidence that MASLD was independently related to significant liver fibrosis (OR = 1.473, 95% CI: 0.970–2.236; P = 0.069). Restricting the analysis to patients whose ALT and AST values did not exceed 5 × the upper limit of normal produced an effect estimate in the same direction, but statistical significance was still not achieved (OR = 1.374, 95% CI: 0.860–2.195; P = 0.183). Older age, male sex, and elevated AST levels were consistently related to significant liver fibrosis in both the primary and sensitivity analyses. HBV DNA showed a significant association only in the primary model. The interaction between MASLD and antiviral treatment status was not statistically significant (P for interaction = 0.232). Concomitant MASLD was common among hospitalized patients with CHB. In the adjusted model, MASLD did not show a clear independent relationship with significant liver fibrosis. In contrast, older age, male sex, and higher AST levels were linked to greater odds of significant liver fibrosis. Because all participants were inpatients, these findings should not be directly extrapolated to the broader CHB population. Further multicenter studies enrolling patients across inpatient, outpatient, and community settings are needed to validate these findings.