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Association between Chronic Liver Disease Caused by Viral Hepatitis, Hospitalisation for COVID-19 and Mortality
Javaria Aslam1, Fahad Qaisar2, Mutahra Khaliq2
1Department of Medicine, Sir Sadiq Abbasi Hospital Bahawalpur, Qauid-e-Azam Medical College, Bahawalpur, Pakistan.
Insights
Patients with chronic liver disease (CLD) due to viral hepatitis were less likely to be hospitalized for COVID-19. CLD patients also experienced reduced severity and mortality from COVID-19 compared to those with other comorbidities.
Area of Science:
- Hepatology and Infectious Diseases
- Epidemiology and Public Health
Background:
- The impact of chronic liver disease (CLD) on COVID-19 outcomes remains an area of significant interest.
- Viral hepatitis B and C are major causes of CLD globally, necessitating an understanding of their role in the context of infectious diseases like COVID-19.
Purpose of the Study:
- To investigate the association between chronic liver disease (CLD) from viral hepatitis and COVID-19 hospitalization.
- To assess the risk of severe COVID-19 disease progression and mortality in patients with prior CLD status.
Main Methods:
- A cohort study was conducted in Pakistan from July to December 2021.
- The study compared COVID-19 hospitalization rates in CLD patients versus the general population, using non-COVID medical admissions as controls.
- Sub-group analyses examined disease severity and mortality risks among COVID-19 patients with and without CLD.
Main Results:
- A total of 3,976 participants were analyzed. Patients with CLD showed a significantly lower likelihood of COVID-19 hospitalization (1.7% vs. 8.8%).
- Among COVID-19 admitted patients, CLD was associated with a decreased risk of death compared to those with other comorbid conditions (14.8% vs. 36.9%).
- CLD patients admitted for COVID-19 had a lower risk of death compared to those admitted for non-COVID CLD-related complications (14.8% vs. 35.1%).
Conclusions:
- Chronic liver disease caused by viral hepatitis is associated with a reduced likelihood of COVID-19 hospitalization.
- Patients with CLD exhibit a lower risk of severe COVID-19 and associated mortality compared to individuals with other comorbidities.
Objective:
To evaluate the association between chronic liver disease (CLD) caused by viral hepatitis and COVID-19 hospitalisation, as well as the risk of disease progression and mortality among COVID-19 hospitalised patients in relation to their prior CLD status.
Study Design:
A cohort study. Place and Duration of the study: Bahawal Victoria Hospital and Sir Sadiq Abbasi hospital, affiliated with Qauid-e-Azam Medical College, Bahawalpur, Pakistan, from July to December 2021.
Methodology:
In the main group analysis, the risk of hospitalisation for COVID-19 among CLD patients was determined, with the presence of CLD due to chronic viral hepatitis B and C as the exposure variable and hospitalisation for COVID-19 as the outcome measure. Patients hospitalised for a medical condition other than COVID-19 (non-COVID medical admissions) served as an external control group. In the sub-group analysis, the risk of disease severity and mortality were determined among COVID-19 admitted patients having a prior status of CLD, with disease progression to death serving as the primary outcome measure while the exposure variable remained the same as in the main analysis.
Results:
A total of 3,976 participants [mean age 51 ±14.8 years; 54.1% men; 1616 hospitalised with COVID-19, including 27 (1.7%) exposed to CLD; and 2,360 non-COVID medical admissions, including 208 (8.8%) exposed to CLD] were evaluated. There was less likelihood of hospitalisation for COVID-19 among patients with CLD (1.7% vs. 8.8%; RR=0.270; 95% CI=0.189, 0.386; p<0.001). There was less risk of death among CLD patients admitted for COVID-19 when compared with those admitted for non-COVID CLD-related complications (14.8% vs. 35.1%; RR= 0.422; 95% CI=0.168-1.06; p=0.035). Among COVID-19 admissions, CLD was associated with a decreased risk of death compared with other comorbid conditions (14.8% vs. 36.9%; RR=0.401; 95% CI=0.162-0.994; p=0.04).
Conclusion:
CLD caused by viral hepatitis was significantly less likely to be present among COVID-19 hospitalised patients. There was a lower risk of severe COVID-19 and mortality owing to it among CLD patients compared to those with other comorbid conditions.
Key Words:
COVID-19, Hospitalisations, Chronic liver disease, Viral hepatitis, COVID-19 severity, Death outcome.
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