Liver biomarkers and Hepatitis B virus infection outcome in southwestern Nigeria

Background: Chronic hepatitis B virus (HBV) infection remains a major public health problem in Nigeria and other parts of sub-Saharan Africa, contributing significantly to liver cirrhosis and hepatocellular carcinoma (HCC). Liver biochemical markers are routinely used to assess hepatic injury and function, but their predictive value for HBV disease progression remains incompletely understood.
Methods: This cross-sectional study involved 114 patients with chronic HBV infection recruited from tertiary hospitals in Southwestern Nigeria. Participants were categorized into asymptomatic inactive carriers (n=17), active symptomatic carriers (n=69), clearance group (n=10), and patients with cirrhosis/HCC (n=18). Liver biochemical markers including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin, total protein, total bilirubin, and conjugated bilirubin were measured using standard enzymatic methods. Associations between biomarkers and disease outcomes were assessed using independent t-tests, one-way ANOVA, and multivariable logistic regression analysis.
Results: The mean age of participants was 38.78 ± 13.76 years, and 53.5% were male. Among the liver biomarkers evaluated, only albumin showed significant variation across HBV disease stages (p < 0.001), with the lowest levels observed in patients with cirrhosis/HCC (28.34 ± 17.29 g/L). Cirrhotic patients had significantly higher ALT (p = 0.034) and ALP (p = 0.021) levels and significantly lower albumin concentrations (p < 0.001) than non-cirrhotic patients. Patients with HCC also demonstrated significantly higher ALT (p = 0.050) and lower albumin levels (p < 0.001) compared with non-cirrhotic patients. Multivariable logistic regression identified serum albumin as the only independent predictor of HBV outcome (OR = 0.902, 95% CI: 0.841–0.967, p = 0.004), while AST, ALT, AST/ALT ratio, bilirubin levels, total protein, age, and gender were not significant predictors.
Conclusion: Serum albumin was significantly associated with HBV disease severity and emerged as the only independent predictor of disease outcome. These findings suggest that albumin may serve as a simple, inexpensive, and readily available biomarker for risk stratification and monitoring of disease progression among patients with chronic HBV infection in Southwestern Nigeria.