IMPACT OF HISTORY OF CHRONIC VIRAL HEPATITIS AND LIVER FIBROSIS ON RISK OF HOSPITALIZATION AND DEATH AMONG PATIENTS WITH SARS-COV-2 INFECTION

Document Type

Conference Proceeding

Publication Date

11-2020

Publication Title

Hepatology

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.

Volume

2020

Issue

72

First Page

280A

Last Page

281A

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