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Corticosteroid treatment in severe patients with SARS-CoV-2 and chronic HBV co-infection: a retrospective multicenter
Mei Meng1, Yufeng Chu2, Sheng Zhang1
1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Rui Jin 2nd Road, Shanghai, 200025, China.
Insights
Corticosteroid treatment in severe COVID-19/HBV co-infected patients was linked to higher mortality. This study found corticosteroids increased risks for 28-day mortality, viral clearance delay, and liver injury in these patients.
Area of Science:
- Infectious Diseases
- Hepatology
- Critical Care Medicine
Background:
- The impact of corticosteroids on severe COVID-19 with chronic Hepatitis B virus (HBV) co-infection remains unclear.
- Chronic HBV infection prevalence is moderate to high in certain regions, making this co-infection relevant.
Purpose of the Study:
- To investigate the association between corticosteroid use and outcomes in patients with severe COVID-19 and chronic HBV co-infection.
- To identify risk factors for mortality and adverse events in this specific patient population.
Main Methods:
- Retrospective multicenter study of 5447 COVID-19 patients, identifying 105 severe cases with chronic HBV co-infection.
- Used multivariable logistic regression and inverse probability of treatment weighting (IPTW) to minimize confounding variables.
- Defined severe COVID-19 based on respiratory distress and oxygenation criteria.
Main Results:
- Corticosteroid therapy was an independent risk factor for 28-day mortality (OR, 6.32).
- Associated with delayed SARS-CoV-2 viral RNA clearance (OR, 2.95), increased 28-day and in-hospital mortality (ORs 4.90 and 5.64, respectively), and acute liver injury (OR, 4.50).
- Higher methylprednisolone doses were observed in non-survivors.
Conclusions:
- Corticosteroid treatment in severe COVID-19/HBV co-infection is associated with increased 28-day and in-hospital mortality.
- Findings suggest caution when using corticosteroids in this vulnerable patient group.
Background:
The impact of corticosteroids on patients with severe coronavirus disease 2019 (COVID-19)/chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate the association of corticosteroids on these patients.
Methods:
This retrospective multicenter study screened 5447 confirmed COVID-19 patients hospitalized between Jan 1, 2020 to Apr 18, 2020 in seven centers in China, where the prevalence of chronic HBV infection is moderate to high. Severe patients who had chronic HBV and acute SARS-cov-2 infection were potentially eligible. The diagnosis of chronic HBV infection was based on positive testing for hepatitis B surface antigen (HBsAg) or HBV DNA during hospitalization and a medical history of chronic HBV infection. Severe patients (meeting one of following criteria: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air; or oxygen index < 300 mmHg) with COVID-19/HBV co-infection were identified. The bias of confounding variables on corticosteroids effects was minimized using multivariable logistic regression model and inverse probability of treatment weighting (IPTW) based on propensity score.
Results:
The prevalence of HBV co-infection in COVID-19 patients was 4.1%. There were 105 patients with severe COVID-19/HBV co-infections (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. In the multivariable analysis, corticosteroid therapy (OR, 6.32, 95% CI 1.17-34.24, P = 0.033) was identified as an independent risk factor for 28-day mortality. With IPTW analysis, corticosteroid treatment was associated with delayed SARS-CoV-2 viral RNA clearance (OR, 2.95, 95% CI 1.63-5.32, P < 0.001), increased risk of 28-day and in-hospital mortality (OR, 4.90, 95% CI 1.68-14.28, P = 0.004; OR, 5.64, 95% CI 1.95-16.30, P = 0.001, respectively), and acute liver injury (OR, 4.50, 95% CI 2.57-7.85, P < 0.001). Methylprednisolone dose per day and cumulative dose in non-survivors were significantly higher than in survivors.
Conclusions:
In patients with severe COVID-19/HBV co-infection, corticosteroid treatment may be associated with increased risk of 28-day and in-hospital mortality.
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