IMPACT OF HISTORY OF CHRONIC VIRAL HEPATITIS AND LIVER FIBROSIS ON RISK OF HOSPITALIZATION AND DEATH AMONG PATIENTS WITH SARS-COV-2 INFECTION
Lu M, Rupp LB, Boscarino JA, Schmidt MA, Daida Y, Zhou YR, Trudeau S, Li J, and Gordon SC. IMPACT OF HISTORY OF CHRONIC VIRAL HEPATITIS AND LIVER FIBROSIS ON RISK OF HOSPITALIZATION AND DEATH AMONG PATIENTS WITH SARS-COV-2 INFECTION. Hepatology 2020; 72:280A-281A.
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.