Current and Past Infections of HBV Do Not Increase Mortality in Patients With COVID‐19

Abstract

BaCKgRoUND aND aIMS:We compared risk of acute liver injury and mortality in patients with COVID-19 and current, past, and no HBV infection. appRoaCH aND ReSUltS: This was a territory-wide retrospective cohort study in Hong Kong. Patients with COVID-19 between January 23, 2020, and January 1, 2021, were identified. Patients with hepatitis C or no HBsAg results were excluded. The primary outcome was mortality. Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase ≥2 × upper limit of normal (ULN; i.e., 80 U/L), with total bilirubin ≥2 × ULN (i.e., 2.2 mg/dL) and/or international normalized ratio ≥1.7. Of 5,639 patients included, 353 (6.3%) and 359 (6.4%) had current and past HBV infection, respectively. Compared to patients without known HBV exposure, current HBV-infected patients were older and more likely to have cirrhosis. Past HBV-infected patients were the oldest, and more had diabetes and cardiovascular disease. At a median follow-up of 14 (9-20) days, 138 (2.4%) patients died; acute liver injury occurred in 58 (1.2%), 8 (2.3%), and 11 (3.1%) patients with no, current, and past HBV infection, respectively. Acute liver injury (adjusted HR [aHR], 2.45; 95% CI, 1.52-3.96; P < 0.001), but not current (aHR, 1.29; 95% CI, 0.61-2.70; P = 0.507) or past (aHR, 0.90; 95% CI, 0.56-1.46; P = 0.681) HBV infection, was associated with mortality. Use of corticosteroid, antifungal, ribavirin, or lopinavir-ritonavir (adjusted OR [aOR], 2.55-5.63), but not current (aOR, 1.93; 95% CI, 0.88-4.24; P = 0.102) or past (aOR, 1.25; 95% CI, 0.62-2.55; P = 0.533) HBV infection, was associated with acute liver injury.CoNClUSIoN: Current or past HBV infections were not associated with more liver injury and mortality in COVID-19. (Hepatology 2021;0:1-16). COVID-19 has spread rapidly throughout the world since late 2019. It has resulted in more than 129 million confirmed cases and 2.83 million deaths globally as of April 3, 2021. (1) Liver injury is commonly observed in patients with COVID-19, in the form of either hepatitis or cholestasis or both, (2) and

Abnormal Liver Function Tests Were Associated With Adverse Clinical Outcomes: An Observational Cohort Study of 2,912 Patients With COVID-19

“…The prevalence of chronic liver disease in our cohort was 2.3%, which is within the range (2–11%) reported in recent data from other cohorts ( 45 – 48 ). Previous studies showed that those with chronic liver disease are more likely to have more adverse outcomes and mortality when compared to those without ( 49 – 52 ).…”

Management of hepatitis B virus reactivation due to treatment of COVID-19

“…However, other studies showed no difference in clinical outcomes or even fewer adverse clinical outcomes in COVID-19 patients with CHB, compared to those without CHB [ 3 , 31 – 33 ]. Most recently, a study from Hong Kong investigated the risk of COVID-19-related mortality in 353 patients with current and 359 with past HBV infection [ 4 ]. This study showed that liver injury, but neither current nor past HBV infection, is associated with COVID-19-related mortality.…”

Liver and COVID-19: From care of patients with liver diseases to liver injury

“…Akin to HBV infection, one of the largest cohorts of patients with COVID-19 and past or current HBV infection did not show an association with acute liver injury. Patients that fulfill the criteria for HBV treatment or under corticosteroid therapy should receive antiviral treatment but it may not be necessary in all patients with COVID-19 and current or past HBV infection[ 51 ]. A study by Liu et al [ 52 ] also reported that HBV infection did not predispose COVID-19 patients to more severe outcomes.…”