Clinical characteristics and risk factors of COVID-19 patients with chronic hepatitis B: a multi-center retrospective cohort study

Abstract

The Coronavirus disease 2019 (COVID-19) has spread globally. Although mixed liver impairment has been reported in COVID-19 patients, the association of liver injury caused by specific subtype especially chronic hepatitis B (CHB) with COVID-19 has not been elucidated. In this multi-center, retrospective, and observational cohort study, 109 CHB and 327 non-CHB patients with COVID-19 were propensity score matched at an approximate ratio of 3:1 on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, disease severity, and clinical outcomes were compared. Furthermore, univariable and multivariable logistic and Cox regression models were used to explore the risk factors for disease severity and mortality, respectively. A higher proportion of CHB patients (30 of 109 (27.52%)) developed into severe status than non-CHB patients (17 of 327 (5.20%)). In addition to previously reported liver impairment markers, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin, we identified several novel risk factors including elevated lactate dehydrogenase (⩾ 245 U/L, hazard ratio (HR) = 8.639, 95% confidence interval (CI) = 2.528–29.523; P < 0.001) and coagulation-related biomarker D-dimer (⩾ 0.5 µg/mL, HR = 4.321, 95% CI = 1.443–12.939; P = 0.009) and decreased albumin (< 35 g/L, HR = 0.131, 95% CI = 0.048–0.361; P < 0.001) and albumin/globulin ratio (< 1.5, HR = 0.123, 95% CI = 0.017–0.918; P = 0.041). In conclusion, COVID-19 patients with CHB were more likely to develop into severe illness and die. The risk factors that we identified may be helpful for early clinical surveillance of critical progression. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s11684-021-0854-5 and is accessible for authorized users.

The Effect of Covid-19 on Liver

“…According to (Huang et al, 2020), who stated that 98% of the infected patients experienced fever followed by cough (76%), dyspnea (55%) and loss of taste or smell, symptoms can include fever. The results corroborate with those of Wang et al (2022) who discovered that diarrhoea was present in 34.0% of cases. Although Covid-19 has a number of mechanisms that can produce symptoms, the one that causes headaches is still unknown.…”

Safety and antibody response to inactivated COVID‐19 vaccine in patients with chronic hepatitis B virus infection

“…Patients with liver diseases may have a greater risk of worse outcome from COVID-19 than the general population. [1][2][3] Currently, there are about 292 million people worldwide infected with HBV and 86 million in China alone. 4 Vaccination is an effective intervention in preventing SARS-CoV-2 infection, severe symptom and death.…”

“…COVID‐19 caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has emerged as a major burden worldwide, resulting in serious public health challenges. Patients with liver diseases may have a greater risk of worse outcome from COVID‐19 than the general population 1‐3 . Currently, there are about 292 million people worldwide infected with HBV and 86 million in China alone 4 …”

Patterns of liver profile disturbance in patients with COVID-19

“…Only one of their patients developed severe COVID-19, thus they suggested that CHB does not affect the outcome of COVID-19. In contrast, a recent study by Wang et al [ 60 ] included 109 patients with CHB and 327 patients without HBV infection, and reported that patients with CHB were more likely to develop severe COVID-19 disease (27.5% vs 5.2%, respectively) with higher mortality. They have reported that factors affecting COVID-19 severity in patients with CHB include elevated total bilirubin, ALP, AST, ALT, LDH and D-dimer and decreased serum albumin and albumin to globulin ratio[ 60 ].…”