Characteristics of liver function in patients with SARS-CoV-2 and chronic HBV co-infection

Xiaojing Zou

Minghao Fang

Shusheng Li

Liang Wu

Renjie Li+5 authors

Summary

Background and aims

Coronavirus disease 2019 (COVID-19) is a major global health threat. We aimed to describe the characteristics of liver function in patients with SARS-CoV-2 and chronic hepatitis B virus (HBV) co-infection.

Methods

We enrolled all adult patients with SARS-CoV-2 and chronic HBV co-infection admitted to Tongji Hospital from February 1 to February 29, 2020. Data of demographic, clinical characteristics, laboratory tests, treatments, and clinical outcomes were collected. The characteristics of liver function and its relation with the severity and prognosis of disease were described.

Results

Of 105 SARS-CoV-2 and chronic HBV co-infected patients, elevated levels of liver test were seen in several patients at admission, including elevated levels of alanine aminotransferase (22,20.95%), aspartate aminotransferase (29, 27.62%), total bilirubin (7, 6.67%), gamma-glutamyl transferase (7, 6.67%) and alkaline phosphatase (1, 0.95%). The values of the indices mentioned above increased substantially during hospitalization (all P<0.05). 14 (13.33%) patients developed liver injury. Most of them (10, 71.43%) recovered after 8 (range 6-21) days. Notably, 4 (28.57%) patients rapidly progressed to acute-on-chronic liver failure. The proportion of severe COVID-19 was higher in patients with liver injury (P= 0.042). Complications including ACLF, acute cardiac injury and shock happened more frequently in patients with liver injury (all P<0.05). The mortality was higher in individuals with liver injury (28.57% vs 3.30%, P=0.004).

Conclusion

Liver injury in patients with SARS-CoV-2 and chronic HBV co-infection was associated with severity and poor prognosis of disease. During the treatment of COVID-19 in chronic HBV-infected patients, liver function should be taken seriously and evaluated frequently.

Keywords: SARS-CoV-2, COVID-19, HBV, liver injury

^{Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China}

^{Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China}

^{Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China}

^{Department of Medical Records, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China}

^{Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China}

^{Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China}

Jiao Huang: moc.361@9101oaijgnauh

^{Correspondence to: Jiao Huang, PhD, Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.}moc.361@9101oaijgnauh

^{Contributed equally}

Received 2020 Apr 27; Revised 2020 Jun 6; Accepted 2020 Jun 11.

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Footnotes

Potential conflicts of interest.

All authors declare no potential conflicts of interest.

Authors’ contributions

Dr. Zou XJ, Huang J and Prof. Fang MH conceived the study idea, analyzed the data, and prepared the article. Dr. Gao B, Gao H, Ran X, Bian Y, Yu SS, Li RJ, Ling JM and Li DH acquired the data. Prof. Li SS, Wu L and Tian DY revised the article critically for important intellectual content. All authors contributed to manuscript preparation.

Funding.

This work was supported by the Fundamental Research Funds for the Central Universities, China (2020kfyXGYJ087).

Background

We described the characteristics of liver function and its relation with severity and prognosis in patients with SARS-CoV-2 and chronic hepatitis B virus (HBV) co-infection.

Findings

Patients with SARS-CoV-2 and chronic HBV co-infection who developed liver injury were more likely to progress into severe illness and had a worse prognosis including higher mortality and incidence of complications such as acute-on-chronic liver failure, acute cardiac injury and shock.

Implications for patient care

Liver function should be evaluated more frequently in patients with SARS-CoV-2 and chronic HBV co-infection, especially within one week after admission.