Pro-brain natriuretic peptide, HbA1c, and C-Reactive protein unveil a distinct inflammatory–glycemic–cardiorenal signature associated with hepatitis B virus infection in diabetic kidney disease

Aim To determine whether hepatitis B virus (HBV) infection is associated with a multidomain inflammatory–glycemic–cardiorenal biomarker signature in adults with diabetes mellitus and diabetic kidney disease (DKD).Methods This multicenter analytical cross-sectional study included 284 adults with DKD: 148 HBV-positive and 136 HBV-negative. C-reactive protein (CRP), HbA1c, lactate dehydrogenase, D-dimer, ferritin, procalcitonin and natriuretic peptide were examined using biomarker-specific available-case analyses. Pearson’s chi-square or exact tests assessed categorical distributions, while Welch’s t-test compared natriuretic-peptide concentrations. Effect sizes and false-discovery-rate-adjusted q-values were reported.Results CRP severity distribution differed by HBV infection (χ2 = 11.73; p = 0.008; q = 0.029), with moderate abnormalities more frequent in HBV-positive participants (20.3% vs 8.8%). Record-level HbA1c severity also differed (χ2 = 17.70; p < 0.001; q = 0.004), with severe abnormalities more frequent in HBV-positive records (22.6% vs 10.1%), although participant-level confirmation is required. Natriuretic-peptide concentrations were markedly higher in HBV-positive participants (21,451.21 ± 16,409.51 vs 128.19 ± 28.42; p = 0.014; q = 0.032). Other biomarkers were not significantly different.Conclusion HBV infection was associated with a differentiated biomarker pattern in DKD, led by inflammatory redistribution, a provisional glycemic signal and marked cardiorenal separation. These exploratory findings require prospective, confounder-adjusted validation. They do not establish causality, cardiac dysfunction, independent prediction, or prognostic utility and should not guide immediate clinical decisions alone.