RISK FACTORS FOR SARS-COV-2 INFECTION AMONG PATIENTS WITH CHRONIC VIRAL HEPATITIS
Gordon SC, Rupp LB, Boscarino JA, Daida Y, Schmidt MA, Zhou YR, Trudeau S, Li J, and Lu M. RISK FACTORS FOR SARS-COV-2 INFECTION AMONG PATIENTS WITH CHRONIC VIRAL HEPATITIS. Hepatology 2020; 72:299A-300A.
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 with p-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.