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

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; Xiao-ping Chen

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

Author: Jing WANG ¹ ; Zequn LU ² ; Meng JIN ³ ; Ying WANG ⁴ ; Kunming TIAN ⁵ ; Jun XIAO ¹ ; Yimin CAI ² ; Yanan WANG ¹ ; Xu ZHANG ⁶ ; Tao CHEN ⁷ ; Zhi YAO ⁸ ; Chunguang YANG ¹ ; Renli DENG ⁹ ; Qiang ZHONG ¹⁰ ; Xiongbo DENG ¹¹ ; Xin CHEN ¹² ; Xiang-Ping YANG ¹³ ; Gonghong WEI ¹⁴ ; Zhihua WANG ¹⁵ ; Jianbo TIAN ¹⁶ ; Xiao-Ping CHEN ¹⁷
Author Information

1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
2. Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
3. Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
4. Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, 430024, China.
5. Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
6. Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
7. Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
8. Department of Respirology and Tuberculosis Specialty, Wuhan Pulmonary Hospital, Wuhan, 430030, China.
9. The Fifth Affiliated (Zhuhai) Hospital of Zunyi Medical University, Zhuhai, 519199, China.
10. Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
11. Department of Radiology, Wuhan Jinyintan Hospital, Wuhan, 430048, China.
12. Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
13. Department of Immunology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
14. Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, 90014, Finland.
15. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. zhwang_hust@hotmail.com.
16. Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. tianjb@hust.edu.cn.
17. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. chenxpchenxp@163.com.
Publication Type:Observational Study
Keywords: COVID-19; chronic hepatitis B; coagulation dysfunction; liver injury
MeSH: COVID-19; Cohort Studies; Hepatitis B, Chronic/epidemiology*; Humans; Retrospective Studies; Risk Factors
From: Frontiers of Medicine 2022;16(1):111-125
CountryChina
Language:English
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.