Clinical Effect of Hepatitis B Virus on COVID-19 Infected Patients: A Nationwide Population-Based Study Using the Health Insurance Review & Assessment Service Database

Abstract

Background Several studies have recently suggested that liver disease and cirrhosis were risk factors for poor outcomes in patients with coronavirus disease 2019 (COVID-19) infections. However, no large data study has reported the clinical course of COVID-19 patients with chronic hepatitis B virus (HBV) infections. This study investigated whether HBV infection had negative impacts on the clinical outcomes of COVID-19 patients. Methods We performed a nationwide population-based cohort study with 19,160 COVID-19-infected patients in 2020 from the Korean Health Insurance Review and Assessment database. The clinical outcomes of COVID-19 patients with chronic HBV infections were assessed and compared to those of non-HBV-infected patients. Results Of the 19,160 patients diagnosed with COVID-19, 675 (3.5%) patients had chronic HBV infections. The HBV-infected patients were older and had more commodities than the non-HBV infected COVID-19 patients. During the observation period, COVID-19-related mortality was seen in 1,524 (8.2%) of the non-HBV-infected 18,485 patients, whereas 91 (13.5%) in HBV-infected 675 patients died of COVID-19 infection. Compared to patients without HBV infections, a higher proportion of patients with chronic HBV infections required intensive care unit (ICU) admission and had organ failures. However, odds ratios for mortality, ICU admission, and organ failure were comparable between the two groups after adjusting for age, sex, and comorbid diseases including liver cirrhosis and hepatocellular carcinoma. Conclusion COVID-19-infected patients with HBV infections showed worse clinical courses than non-HBV-infected COVID-19 patients. However, after adjustment, chronic HBV infection itself does not seem to affect the clinical outcomes in COVID-19 patients.

SARS-CoV-2 infection and liver involvement

“…Various studies have also investigated the relationship between anti-viral treatment for HBV and outcomes from SARS-CoV-2 infection. In a Korean retrospective study of 19,160 patients with COVID-19, Choe et al demonstrated that anti-viral treatment among HBV-infected patients was not associated with reduced mortality, hospitalisation stay, or rate of ICU admission compared to patients without antiviral therapy [ 44 ]. Of note, the antiviral-treated group showed higher proportion with progression to liver failure than their counterparts (4.3% vs. 1.3%; p = 0.032).…”

Impact of chronic liver disease on SARS-CoV-2 infection outcomes: Roles of stage, etiology and vaccination

“…Neither the degree of HBV replicative activity seems to affect the SARS-CoV-2 infection outcomes; inactive carriers or patients with previous infection have ALI and mortality rates comparable to patients with active hepatitis[ 57 , 58 ]. As further demonstration of the absence of correlation between HBV replicative activity and COVID-19-related outcomes, antiviral therapy for HBV is not able to determine a significant impact on mortality, need for admission to the ICU and hospitalization length[ 59 ]. Apparently, conflicting with these data, Yang et al [ 60 ] showed that the HBeAg-positive chronic HBV hepatitis are associated with a higher rate of hospitalization in ICU and mortality.…”

Outcomes of COVID-19 among patients with liver disease

“…A study conducted in the United States reported that chronic hepatitis C in COVID-19 patients was associated with in-hospital mortality regardless of baseline comorbidities, admission values of laboratory tests, or liver damage induced by COVID-19[ 63 ]. The Korean nationwide population-based cohort study reported that after adjusting for age, sex, cirrhosis, and comorbidities, HBV infection itself appears not to influence the prognosis of COVID-19 patients[ 64 ].…”