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Liver dysfunction and clinical outcomes of unvaccinated COVID-19 patients with and without chronic hepatitis B
Hao-Che Chang1, Tung-Hung Su2, Yu-Tsung Huang3
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Chronic hepatitis B patients with COVID-19 experienced higher liver enzyme levels and prolonged hospital stays. Elevated aspartate aminotransferase (AST) indicates severe COVID-19 and intensive care unit admission risk.
Area of Science:
- Hepatology
- Infectious Diseases
- Virology
Background:
- Liver dysfunction is a frequent complication of COVID-19.
- The specific impact on patients with chronic hepatitis B (CHB) is not well understood.
Purpose of the Study:
- To investigate liver dysfunction in COVID-19 patients.
- To assess the clinical impact of COVID-19 on patients with and without CHB.
Main Methods:
- Retrospective cohort study of 109 unvaccinated COVID-19 patients.
- Stratification based on hepatitis B surface antigen (HBsAg) serostatus.
- Analysis of demographics, laboratory data, hospitalization course, and clinical outcomes.
Main Results:
- HBsAg-positive patients showed higher ALT and platelet levels, and longer hospitalizations.
- No significant differences in hepatitis, oxygen use, ventilation, specific treatments, ICU admission, or mortality.
- Older age and higher AST correlated with oxygen supplementation; higher AST predicted ICU admission.
- Oxygen use and shock were associated with liver dysfunction.
Conclusions:
- CHB patients exhibit elevated ALT and longer hospitalizations during COVID-19.
- Higher AST levels are predictive of severe COVID-19 and ICU admission.
Background:
Liver dysfunction is common during coronavirus disease 2019 (COVID-19), while its clinical impact and association with chronic hepatitis B (CHB) remain uncertain. We aimed to investigate liver dysfunction in COVID-19 patients and its impacts on those with/without CHB.
Methods:
We conducted a retrospective cohort study of COVID-19 patients at National Taiwan University Hospital, stratified according to hepatitis B surface antigen (HBsAg) serostatus, with demographics, laboratory data, and hospitalization course reviewed, and clinical outcomes compared through multivariable analyses.
Results:
We enrolled 109 COVID-19 patients unvaccinated against SARS-CoV-2 by August 2021. The HBsAg-positive group (n = 34) had significantly higher alanine aminotransferase (ALT) (26 vs. 16 U/L, P = 0.034), platelet (224 vs. 183 k/μL, P = 0.010) and longer hospitalizations (17 vs. 13 days, P = 0.012) compared with HBsAg-negative group (n = 75), while percentages of hepatitis (2-fold ALT elevation), oxygen supplementation, ventilators usage, COVID-specific treatment, intensive care unit (ICU) admission and mortality were comparable. Older age (odds ratio [OR]: 1.04, 95 % confidence interval [CI]: 1.00-1.08, P = 0.032) and higher aspartate aminotransferase (AST) (OR: 1.08, 95 % CI: 1.004-1.16, P = 0.038) were associated with oxygen supplementation according to multivariable analyses. Higher AST predicted ICU admission (OR: 1.11, 95 % CI: 1.03-1.19, P = 0.008). Oxygen usage (OR: 5.64, 95 % CI: 1.67-19.09, P = 0.005) and shock (OR: 5.12, 95 % CI: 1.14-22.91, P = 0.033) were associated with liver dysfunction.
Conclusions:
CHB patients had higher ALT levels and longer hospitalizations during COVID-19. Higher AST levels predict severe COVID-19 and ICU admission.
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