Epidemiological and clinical characteristics of 70 cases of coronavirus disease and concomitant hepatitis B virus infection: A multicentre descriptive study

Abstract

The interaction between existing chronic liver diseases caused by hepatitis B virus (HBV) infection and COVID‐19 has not been studied. We analysed 70 COVID‐19 cases combined with HBV infection (CHI) to determine the epidemiological, clinical characteristics, treatment and outcome. We investigated clinical presentation, imaging and laboratory parameters of COVID‐19 patients of seven hospitals from Jan 20 to March 20, 2020. Multivariate analysis was used to analyse risk factors for progression of patients with COVID‐19 combined with HBV infection. Compared with COVID‐19 without HBV infection (WHI) group, patients with dual infection had a higher proportion of severe/critically ill disease (32.86% vs. 15.27%, P = .000), higher levels of alanine aminotransferase (ALT), aspartate transaminase (AST) and activated partial thromboplastin (APTT) [50(28‐69)vs 21(14‐30), P = .000; 40(25‐54) vs 23(18‐30), P = .000; 34.0(27.2‐38.7) vs 37.2(31.1‐41.4), P = .031]. The utilization rates of Arbidol and immunoglobulin were significantly higher than those in the co‐infected group [48.57% vs. 35.64%, P < .05; 21.43% vs. 8.18%, P < .001], while the utilization rate of chloroquine phosphate was lower (1.43% vs 14.00%, P < .05) in the co‐infected patients group. Age and c‐reactive protein (CRP) level were independent risk factors for recovery of patients with COVID‐19 combined with HBV infection. The original characteristics of COVID‐19 cases combined with HBV infection were higher rate of liver injury, coagulation disorders, severe/critical tendency and increased susceptibility. The elderly and patients with higher level of CRP were more likely to experience a severe outcome of COVID‐19.

The Complexity of Co-Infections in the Era of COVID-19

“…There are citations of unique co-infections of SARS-CoV-2 with other systemic viral illnesses [101][102][103][104][105][106][107][108][109][110][111]. Such coinfection was particularly of interest in the context of chronic HIV infection where persistent immunocompromise or enhanced infection susceptibility otherwise might allow for either of the infections to be more severe than not [104][105][106]112].…”

“…These studies do not, however, indicate that either of the latter infections markedly affects the other. For chronic hepatitis B patients, early reports suggest that COVID-19 increases the potential for complicating outcomes [107,108]. Others have suggested that chronic hepatitis B did not predispose patients to a more severe outcome [109].…”

HBV coinfection and in-hospital outcomes for COVID-19: a systematic review and meta-analysis

“…An initial search in PubMed, the Cochrane Library, and Embase identified 166 citations. Six full-text articles met selection criteria and were included in the meta-analysis (8)(9)(10)(11)(12)(13).…”

COVID-19 combined with liver injury: Current challenges and management

“…Clinical studies have shown that the abnormal rate and average value of serum ALT and AST levels of SARS-CoV-2-infected patients with hepatitis B virus (HBV) are higher than those in SARS-CoV-2 patients without HBV infection, which indicates that HBV is one of the risk factors for liver injury in COVID-19 patients[ 40 ]. Compared with COVID-19 without HBV infection group, patients with dual infection had a higher proportion of severe/critically ill disease, higher levels of ALT, AST and activated partial thromboplastin[ 41 ]. Of course, there are clinical reports that the abnormalities of liver function are not uncommon on COVID-19 patients with chronic HBV infection in a case series[ 42 ].…”