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KNOWLEDGE TRANSFER STATEMENT: The results of this study can help key stakeholders, such as health care facilities, educational and research institutions, insurance companies, and governmental bodies, plan future activities and policies on dental practice and education.
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Oral Health , Scope of Practice , Delivery of Health Care , Education, Dental , ForecastingABSTRACT
Background: We investigated factors associated with Covid-19 related hospitalization and death among patients with and without a history of chronic viral hepatitis B or C (CHB/CHC) in a single large, integrated health system located in metropolitan Detroit, Michigan, an area that experienced a significant outbreak of SARS-Cov-2 in Spring 2020. Methods: Baseline data were collected before date of first positive SARS-CoV-2 test or Covid-related hospitalization, whichever was earlier Risk of hospitalization was analyzed with logistic regression;risk of death with Cox regression Variables with p-values <0.05 were retained in the final multivariable models Results: Of 6661 patients that tested SARS-CoV-2 positive from March 12-April 26, 2020, 94 (1 4%) had a history of CHB or CHC A total of 2604 were hospitalized due to Covid-19, 55 (58 5%) with CHB or CHC and 2549 (38 8%) without CHB/CHC Among hospitalized patients, 10 (18 2%) CHB/CHC patients and 426 (16 7%) non-hepatitis patients died In multivariable analyses, viral hepatitis was not a risk factor for hospitalization, but approached significance for death (adjusted Hazard Ratio [aHR] 1.82, 95% Confidence Interval [CI] 0 96-3 46) In addition to recognized risk factors for Covid-19 severity such as increasing age, obesity, type 2 diabetes, and multiple co-morbidities, we found that increasing Fibrosis-4 (FIB4) score (a biomarker for liver fibrosis and cirrhosis) was associated with risk of hospitalization (adjusted Odds Ratio [aOR] 95%CI 1 32, 1 16-1 51) African American and male patients were also at higher risk of hospitalization Notably, a number of risk factors for hospitalization were not associated with or were associated with reduced risk of death among hospitalized patients;African American patients and those with BMI ≥30 had lower mortality than White patients and those with BMI <25 (aHR 0 73, 95%CI 0 60-0 89;and aHR 0 69, 95%CI 0 54-0 88) respectively Conclusion: Increasing baseline FIB4 index is associated with higher risk of hospitalization among patients with Covid-19 History of CHB or CHC trended toward increased risk of Covid-related mortality;future studies in larger samples of patients with chronic viral hepatitis are warranted.
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Background: We investigated factors associated with risk of SARS-CoV-2 infection among an established cohort of chronic hepatitis B and C (CHB/ CHC) patients at a large, vertically integrated health system located in southeastern Michigan (which includes Detroit), a racially-diverse area that experienced a significant outbreak of COVID-19 during March-May 2020 Methods: Patient characteristics and clinical conditions were collected for the period prior to date of first positive SARS-CoV-2 test, or March 11, 2020 for those who were not SARS-CoV-2 infected Variables included: age;gender;race;insurance type;household income;BMI;CHC vs. CHB;AST;ALT;liver fibrosis status (as measured by APRI/ FIB4);diagnosis of liver cirrhosis;Charlson-Deyo comorbidity index;select individual comorbidities;and history of antiviral therapy Patients coinfected with both CHB and CHC were excluded Logistic regression, univariate followed by multivariable modeling, was performed Variables withp-values <0.05 were retained in the final model. Results: A total of 13,556 patients with a history of chronic viral hepatitis were included;94 had a positive SARS-CoV-2 result. In univariate comparisons, there was a significant difference between groups (p<0 05) with regard to type of hepatitis infection (C vs B), age, race, BMI, insurance type, household income, comorbidity index, AST, ALT, APRI, presence of cirrhosis, type 2 diabetes, chronic heart disease, renal disease, peripheral vascular disease, history of receipt of antiviral therapy, and achievement of sustained viral response (CHC). In the final multivariable model, increased risk of SARS-CoV-2 infection was associated with CHC vs CHB (adjusted Odds Ratio [aOR])=4.00, 95% confidence interval [CI] 1 89-8 47), presence of cirrhosis (aOR=1 66, 95%CI 1 08-2 55), normal AST at baseline (aOR=2 50, 95%CI 1 46-4 27), higher comorbidity index (aOR=1 40, 95%CI 1 19-1 67), Black/ African American vs white race (aOR=18 0, CI 6 59-45 5), and BMI (BMI 25-30 vs <25: aOR=3.82, CI 1.95-7.49;BMI >30 vs <25: aOR=2.85, CI 1 46-5 56) Conclusion: In a cohort of chronic viral hepatitis patients drawn from a geographic area that experienced a significant COVID-19 outbreak, Black/ African American race, BMI>25, cirrhosis, CHC (active or post-SVR) vs. CHB, and higher comorbidity index were associated with higher risk of SARS-CoV-2 infection.