From the perspective of severe liver fibrosis (as measured by Fibroscan scores), hepatic cytolysis (as measured by mean ALT and AST values), cholestasis (as measured by mean BRT values), protein synthesis, and the effect of coagulation (as measured by mean blood albumin, INR, and platelet count), as well as the progression to cirrhosis and HCC (as measured by the mean value of the AFP), our study identifies the most severe forms of the disease at the patients with HBV/HDV co-infection. The gene discussed is ALB; the disease is cholestasis.