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.

Keywords

COVID-19 / chronic hepatitis B / liver injury / coagulation dysfunction

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Acknowledgements

We thank the assistance of Prof. David Horne from CITY OF HOPE, Prof. Hui Zhu from Cleveland Clinic Foundation, and Prof. Jiping Wang from Northwestern University. This work is supported by the National Natural Science Foundation of China (No. 81974400) and Natural Science Foundation of Zhuhai (No. ZH22036302200081-PWC to Renli Deng). We acknowledge all patients and their families involved in the study and all health-care workers who are fighting against the COVID-19 pandemic.

Compliance with ethics guidelines

Jing Wang, Zequn Lu, Meng Jin, Ying Wang, Kunming Tian, Jun Xiao, Yimin Cai, Yanan Wang, Xu Zhang, Tao Chen, Zhi Yao, Chunguang Yang, Renli Deng, Qiang Zhong, Xiongbo Deng, Xin Chen, Xiang-ping Yang, Gonghong Wei, Zhihua Wang, Jianbo Tian, and Xiao-ping Chen declare that they have no conflict of interest. This study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and granted a waiver of informed consent from study participants.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-021-0854-5 and is accessible for authorized users.

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