Early identification of cirrhosis among patients with hepatitis is important for timely risk stratification and clinical management, yet conventional non-invasive scores such as the fibrosis-4 index (FIB-4) and the aspartate aminotransferase-to-platelet ratio index (APRI) may provide limited discrimination. In clinical datasets, missingness patterns may also carry predictive information, but their value for cirrhosis identification remains insufficiently investigated.

The present study aims to characterize the impact of Epstein-Barr virus (EBV) lytic replication on liver disease in patients with chronic hepatitis B virus (HBV) infection. We retrospectively enrolled 261 patients with HBeAg-negative chronic HBV infection who were admitted to Zhongnan Hospital between 2019 and 2025. Plasma levels of HBV-DNA, EBV-DNA, and liver function parameters were collected. Patients were grouped based on their viral DNA status, and the association between viral DNA status and liver function was evaluated. Compared to the HBV-DNA-negative group, HBV-DNA-positivity was significantly associated with aggravated hepatic injury, as evidenced by elevated ALT, AST, lymphocyte count, and fibrosis scores (APRI and FIB-4). Notably, regardless of HBV-DNA status or the stage of liver disease (CHB or LC), EBV-DNA-positivity was consistently associated with significantly lower plasma albumin (Alb) levels and albumin-to-globulin (A/G) ratio compared to EBV-DNA-negative patients. The reduction in the A/G ratio was attributable to decreased Alb levels rather than to elevated globulin (Glb) levels. These results suggest that EBV lytic replication was associated with hypoalbuminemia in this study. Circulating EBV-DNA status holds promise as a potential biomarker for monitoring disease progression, or assessing disease severity in patients with chronic HBV infection.

ObjectiveTo evaluate associations of non-invasive liver fibrosis indices with optical coherence tomography (OCT)-derived retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness in Korean adults.MethodsThis cross-sectional study used Korea National Health and Nutrition Examination Survey data from 2019-2021. The analytic cohort included 5,830 adults contributing 10,814 eyes after excluding chronic liver disease, ocular disease, and missing or invalid laboratory or ocular data. Primary exposures were fibrosis-4 index (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI), standardized to z scores. Outcomes were corrected average RNFL thickness and average GCIPL thickness. Generalized estimating equation models accounted for inter-eye correlation and adjusted for demographic, ocular, cardiometabolic, and lifestyle covariates.ResultsCorrected average RNFL and GCIPL thickness decreased across FIB-4 categories. In fully adjusted models, higher FIB-4 was associated with thinner corrected average RNFL thickness (β=-0.438 µm; 95% CI, -0.679 to -0.197; P<0.001), as was higher APRI (β=-0.270 µm; 95% CI, -0.461 to -0.078; P=0.006). GCIPL associations were weaker but nominally significant. After false discovery rate correction, only FIB-4 and APRI remained significantly associated with corrected average RNFL thickness. RNFL associations persisted after non-linear age adjustment and in survey-weighted participant-level analyses.ConclusionsHigher non-invasive liver fibrosis indices were associated with slightly thinner OCT-derived neuroretinal measurements, most robustly corrected average RNFL thickness. The small effect sizes support population-level epidemiologic interpretation rather than individual-level clinical use.