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Chronic hepatitis-C infection in COVID-19 patients is associated with in-hospital mortality
Diana Ronderos1, Alaa Mabrouk Salem Omar2, Hafsa Abbas3
1Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States.
Insights
Pre-existing hepatitis C infection (HCV) significantly increases mortality risk in COVID-19 patients. This association persists regardless of liver injury, suggesting extrahepatic effects of HCV worsen COVID-19 outcomes.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited evidence exists on the impact of pre-existing hepatitis C virus (HCV) infection on outcomes for patients with coronavirus disease 2019 (COVID-19).
- Understanding this association is crucial for managing COVID-19 patients with a history of HCV.
Purpose of the Study:
- To determine the prevalence of HCV history in COVID-19 patients.
- To investigate the relationship between HCV and in-hospital mortality, considering COVID-19-induced liver injury and other risk factors.
Main Methods:
- A retrospective single-center study included 1193 patients with COVID-19.
- Patients were categorized into those with (4.1%) and without (95.9%) a history of HCV.
- Multivariate Cox-regression and propensity score matching were employed to analyze mortality predictors.
Main Results:
- HCV, age, D-Dimer, and ferritin were identified as independent predictors of in-hospital mortality.
- No significant difference in acute liver injury or Fib-4 scores was observed between groups.
- HCV independently predicted mortality after propensity score matching, adding predictive value to clinical and laboratory parameters.
Conclusions:
- A history of HCV infection exacerbates severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virulence in COVID-19 patients.
- This effect is independent of comorbidities, admission variables, or COVID-19-induced liver injury.
- Potential mechanisms include HCV's extrahepatic effects on viral entry, inflammation, and endothelial function.
Background:
There is little evidence about the association of pre-existing hepatitis C infection (HCV) with outcomes in patients with coronavirus disease 2019 (COVID-19).
Aim:
To assess the prevalence of history of HCV among patients with COVID-19 and to study the relationship of in-hospital mortality in relation with other predictors of poor outcomes in the presence or absence of COVID-19 induced acute liver injury.
Methods:
In a retrospective single-center study design, 1193 patients with COVID-19 infection were studied. Patients were then classified into those with and without a history of HCV, 50 (4.1%) and 1157 (95.9%) respectively.
Results:
Multivariate cox-regression models showed that age, HCV, D-Dimer, and ferritin were the only predictors of in-hospital mortality. Acute liver injury and fibrosis score (Fib-4 score) were not different between both groups. Multivariate cox-regression model for liver profile revealed that aspartate aminotransferase/ alanine aminotransferase ratio, Fib-4 score, and HCV were predictors of in-hospital mortality. After propensity score matching HCV was the only predictor of mortality in the multivariate cox-regression model. A model including HCV was found to add predictive value to clinical and laboratory parameters.
Conclusion:
In patients with COVID-19, history of HCV infection leads to an accentuated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virulence, irrespective of baseline comorbidities, admission laboratory variables, or COVID-19-induced liver injury, which may be related to extrahepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 viral entry, baseline cytokine-mediated pro-inflammation, and endothelial dysfunction.
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