LAUSR

Background Patients with chronic hepatitis B (CHB) are getting older with the rising prevalence of metabolic comorbidities. We examined its impact on the performance of PAGE-B score among treated CHB patients. Methods Adult CHB patients who had received entecavir or tenofovir for at least 6 months in 2005–2018 were identified in Hong Kong. Diabetes mellitus (DM), hypertension and dyslipidaemia were identified based on diagnosis codes, laboratory measurements, and medication uses. Performance of PAGE-B score on 5-year HCC prediction was assessed by area under the time-dependent receiver operating characteristic curve (AUROC), and the score’s cut-off values were evaluated by survival analysis. Results Of 31,953 identified CHB patients, there was a trend of rising prevalence of metabolic comorbidities over the three periods (2005–2009, 2010–2014, and 2015-June 2018): hypertension 34.2%, 40.3%, and 43.0%; DM 15.2%, 20.0%, and 21.6%; and dyslipidaemia 46.6%, 55.7%, and 62.5%, respectively (all P Conclusions PAGE-B score is accurate across the years to predict HCC, yet has a lower performance in DM patients. HCC risk persists and HCC surveillance is still cost-effective in DM patients classified as low risk by PAGE-B score.