ABSTRACT
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.
ABSTRACT
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.