BACKGROUND AIMS Studies have suggested that patients with chronic hepatitis B (CHB), either co-, or super infected, have more aggressive liver disease progression than those with the hepatitis delta virus (HDV). This systematic literature review and meta-analysis examined whether HDV RNA status is associated with increased risk of advanced liver disease events (ALDEs), in patients who are HBsAg and HDV antibody positive. APPROACH RESULTS A total of 12 publications were included. Relative rates of progression to ALDE for HDV RNA+/detectable versus HDV RNA-/undetectable were extracted for analysis. Reported odds (OR) and hazard ratios (HRs) with 95% confidence intervals (CI) were pooled using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Presence of HDV RNA+ was associated with an increased risk of any ALDE (random effect [95% CI]: risk ratio (RR): 1.48 [0.93, 2.33]; HR: 2.62 [1.55, 4.44]). When compared to HDV RNA- patients, HDV RNA+ was associated with a significantly higher risk of progressing to compensated cirrhosis (RR 1.74 [1.24, 2.45]), decompensated cirrhosis (HR 3.82 [1.60, 9.10]), hepatocellular carcinoma (HR 2.97 [1.87, 4.70]), liver transplantation (HR 7.07 [1.61, 30.99]), and liver-related mortality (HR 3.78 [2.18, 6.56]). CONCLUSION Patients with HDV RNA+ status have a significantly greater risk of liver disease progression than patients who are HDV RNA-. These findings highlight the need for improved HDV screening and linkage to treatment to reduce the risk of liver-related morbidity and mortality.

中文翻译：

---

丁型肝炎病毒与肝脏发病率和死亡率之间的关联：系统文献综述和荟萃分析。

背景 目的 研究表明，慢性乙型肝炎 (CHB) 患者，无论是共同感染还是双重感染，与丁型肝炎病毒 (HDV) 患者相比，其肝病进展更为严重。这项系统性文献综述和荟萃分析研究了 HBsAg 和 HDV 抗体阳性患者中 HDV RNA 状态是否与晚期肝病事件 (ALDE) 风险增加相关。方法结果 总共包含 12 篇出版物。提取 HDV RNA+/可检测到 HDV RNA-/不可检测的进展为 ALDE 的相对比率进行分析。使用 Hartung-Knapp-Sidik-Jonkman 方法对随机效应模型的报告优势 (OR) 和风险比 (HR) 以及 95% 置信区间 (CI) 进行汇总。HDV RNA+ 的存在与任何 ALDE 的风险增加相关（随机效应 [95% CI]：风险比 (RR)：1.48 [0.93，2.33]；HR：2.62 [1.55，4.44]）。与 HDV RNA- 患者相比，HDV RNA+ 与进展为代偿性肝硬化 (RR 1.74 [1.24, 2.45])、失代偿性肝硬化 (HR 3.82 [1.60, 9.10])、肝细胞癌 (HR 2.97 [ 1.87, 4.70]）、肝移植（HR 7.07 [1.61, 30.99]）和肝脏相关死亡率（HR 3.78 [2.18, 6.56]）。结论 HDV RNA+ 状态的患者比 HDV RNA- 状态的患者具有显着更大的肝病进展风险。这些发现强调需要改进丁型肝炎病毒筛查以及与治疗的联系，以降低肝脏相关发病率和死亡率的风险。