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Patients with COVID-19 and HBV Coinfection are at Risk of Poor Prognosis
Shanshan Yang1,2, Shengshu Wang2,3, Mingmei Du1
1Department of Disease Prevention and Control, Chinese PLA General Hospital, The 1st Medical Center, Beijing, 100853, China.
Insights
Hepatitis B virus (HBV) coinfection with COVID-19, particularly HBeAg (+) chronic hepatitis B (CHB), increases the risk of death and critical illness. Abnormal liver function partially explains this heightened risk in HBV-COV-19 patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Investigating the impact of hepatitis B virus (HBV) coinfection on COVID-19 outcomes.
- Examining different stages of HBV infection: resolved, HBeAg (-) CHB, HBeAg (+) CHB, and HBV reactivation.
- Assessing the role of abnormal liver function in mediating COVID-19 prognosis for HBV coinfected patients.
Purpose of the Study:
- To determine if different HBV infection stages impact COVID-19 patient mortality and critical illness risk.
- To ascertain if abnormal liver function mediates the relationship between HBV coinfection and adverse COVID-19 outcomes.
- To quantify the extent to which liver dysfunction contributes to poor prognosis in coinfected individuals.
Main Methods:
- A cohort study of 2899 COVID-19 inpatients in Wuhan, China.
- Patients categorized into five groups based on HBV infection status.
- Follow-up for mortality and ICU admission during hospitalization.
Main Results:
- HBeAg (+) CHB/infection was associated with a 1.86-fold increased risk of ICU admission and a 3.19-fold increased risk of death.
- Abnormal liver function partially mediated the effect of HBeAg (+) CHB/infection on death and ICU stay, accounting for approximately 79.6% and 73.5%, respectively.
- Patients without CHB served as the reference group for adjusted hazard ratios.
Conclusions:
- COVID-19 patients with HBeAg (+) CHB/infection face a significantly higher risk of poor prognosis.
- Abnormal liver function is a partial mediator of the increased risk of poor outcomes in HBV-COV-19 coinfection.
- This highlights the importance of monitoring liver function in COVID-19 patients with HBV.
Introduction:
This study aimed to determine whether there is a difference in the risk of death/critical illness between different stages of hepatitis B virus (HBV) (resolved hepatitis B, HBeAg (-) chronic hepatitis B [CHB]/infection, HBeAg (+) CHB/infection, and HBV reactivation) coinfected with coronavirus disease 2019 (COVID-19); and if there is a difference, whether it is due to abnormal liver function and to what extent.
Methods:
This cohort study included all COVID-19 inpatients of a single-center tertiary care academic hospital in Wuhan, Hubei, China, between February 4, 2020, and follow-up to April 14, 2020. A total of 2899 patients with COVID-19 were included as participants in this study, and they were divided into five groups based on hepatitis B infection status. Follow-up was conducted for mortality and ICU admission during hospitalization.
Results:
The median follow-up time was 39 days (IQR, 30-50), with 66 deaths and 126 ICU admissions. After adjustment, compared with patients without CHB, the hazard ratio (HR) for ICU admission was 1.86 (95% CI: 1.05-3.31) for patients with HBeAg (+) CHB/infection. The HR for death was 3.19 (95% CI: 1.62-6.25) for patients with HBeAg (+) CHB/infection. The results for the mediating effect indicated that the total effect of HBeAg (+) CHB/infection on death/ICU stay was partially mediated by abnormal liver function, which accounted for 79.60% and 73.53%, respectively.
Conclusion:
Patients with COVID-19 coinfected with HBV at the HBeAg (+) CHB/infection stage have an increased risk of poor prognosis, and abnormal liver function partially mediates this increased risk of poor prognosis caused by the coinfection.
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