Current and Past Infections of HBV Do Not Increase Mortality in Patients With COVID‐19

Background and Aims We compared risk of acute liver injury and mortality in patients with COVID‐19 and current, past, and no HBV infection. Approach and Results This was a territory‐wide retrospective cohort study in Hong Kong. Patients with COVID‐19 between January 23, 2020, and January 1, 2021, we...

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Veröffentlicht in:Hepatology (Baltimore, Md.) Md.), 2021-10, Vol.74 (4), p.1750-1765
Hauptverfasser: Yip, Terry Cheuk‐Fung, Wong, Vincent Wai‐Sun, Lui, Grace Chung‐Yan, Chow, Viola Chi‐Ying, Tse, Yee‐Kit, Hui, Vicki Wing‐Ki, Liang, Lilian Yan, Chan, Henry Lik‐Yuen, Hui, David Shu‐Cheong, Wong, Grace Lai‐Hung
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container_issue 4
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container_title Hepatology (Baltimore, Md.)
container_volume 74
creator Yip, Terry Cheuk‐Fung
Wong, Vincent Wai‐Sun
Lui, Grace Chung‐Yan
Chow, Viola Chi‐Ying
Tse, Yee‐Kit
Hui, Vicki Wing‐Ki
Liang, Lilian Yan
Chan, Henry Lik‐Yuen
Hui, David Shu‐Cheong
Wong, Grace Lai‐Hung
description Background and Aims We compared risk of acute liver injury and mortality in patients with COVID‐19 and current, past, and no HBV infection. Approach and Results This was a territory‐wide retrospective cohort study in Hong Kong. Patients with COVID‐19 between January 23, 2020, and January 1, 2021, were identified. Patients with hepatitis C or no HBsAg results were excluded. The primary outcome was mortality. Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase ≥2 × upper limit of normal (ULN; i.e., 80 U/L), with total bilirubin ≥2 × ULN (i.e., 2.2 mg/dL) and/or international normalized ratio ≥1.7. Of 5,639 patients included, 353 (6.3%) and 359 (6.4%) had current and past HBV infection, respectively. Compared to patients without known HBV exposure, current HBV‐infected patients were older and more likely to have cirrhosis. Past HBV‐infected patients were the oldest, and more had diabetes and cardiovascular disease. At a median follow‐up of 14 (9‐20) days, 138 (2.4%) patients died; acute liver injury occurred in 58 (1.2%), 8 (2.3%), and 11 (3.1%) patients with no, current, and past HBV infection, respectively. Acute liver injury (adjusted HR [aHR], 2.45; 95% CI, 1.52‐3.96; P 
doi_str_mv 10.1002/hep.31890
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Approach and Results This was a territory‐wide retrospective cohort study in Hong Kong. Patients with COVID‐19 between January 23, 2020, and January 1, 2021, were identified. Patients with hepatitis C or no HBsAg results were excluded. The primary outcome was mortality. Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase ≥2 × upper limit of normal (ULN; i.e., 80 U/L), with total bilirubin ≥2 × ULN (i.e., 2.2 mg/dL) and/or international normalized ratio ≥1.7. Of 5,639 patients included, 353 (6.3%) and 359 (6.4%) had current and past HBV infection, respectively. Compared to patients without known HBV exposure, current HBV‐infected patients were older and more likely to have cirrhosis. Past HBV‐infected patients were the oldest, and more had diabetes and cardiovascular disease. At a median follow‐up of 14 (9‐20) days, 138 (2.4%) patients died; acute liver injury occurred in 58 (1.2%), 8 (2.3%), and 11 (3.1%) patients with no, current, and past HBV infection, respectively. Acute liver injury (adjusted HR [aHR], 2.45; 95% CI, 1.52‐3.96; P &lt; 0.001), but not current (aHR, 1.29; 95% CI, 0.61‐2.70; P = 0.507) or past (aHR, 0.90; 95% CI, 0.56‐1.46; P = 0.681) HBV infection, was associated with mortality. Use of corticosteroid, antifungal, ribavirin, or lopinavir–ritonavir (adjusted OR [aOR], 2.55‐5.63), but not current (aOR, 1.93; 95% CI, 0.88‐4.24; P = 0.102) or past (aOR, 1.25; 95% CI, 0.62‐2.55; P = 0.533) HBV infection, was associated with acute liver injury. Conclusion Current or past HBV infections were not associated with more liver injury and mortality in COVID‐19.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.31890</identifier><identifier>PMID: 33961298</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Acute Lung Injury - blood ; Acute Lung Injury - diagnosis ; Acute Lung Injury - epidemiology ; Acute Lung Injury - virology ; Adult ; Age Factors ; Aged ; Alanine ; Alanine Transaminase ; Aspartate aminotransferase ; Aspartate Aminotransferases ; Bilirubin ; Cardiovascular diseases ; Cirrhosis ; Corticosteroids ; COVID-19 ; COVID-19 - complications ; COVID-19 - diagnosis ; COVID-19 - mortality ; COVID-19 - virology ; Diabetes mellitus ; Female ; Hepatitis B surface antigen ; Hepatitis B Surface Antigens - isolation &amp; purification ; Hepatitis B virus - immunology ; Hepatitis B virus - isolation &amp; purification ; Hepatitis B, Chronic - complications ; Hepatitis B, Chronic - diagnosis ; Hepatitis B, Chronic - epidemiology ; Hepatitis B, Chronic - virology ; Hepatitis C ; Hepatology ; Hong Kong - epidemiology ; Humans ; Infections ; Liver ; Liver cirrhosis ; Lopinavir ; Male ; Medical History Taking - statistics &amp; numerical data ; Middle Aged ; Mortality ; Original ; Retrospective Studies ; Ribavirin ; Risk Assessment - statistics &amp; numerical data ; Risk Factors ; Ritonavir</subject><ispartof>Hepatology (Baltimore, Md.), 2021-10, Vol.74 (4), p.1750-1765</ispartof><rights>2021 by the American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4430-5415bd5c26b0e02646cbc85704736a37d643c740dd9430ed385d6e65697439d33</citedby><cites>FETCH-LOGICAL-c4430-5415bd5c26b0e02646cbc85704736a37d643c740dd9430ed385d6e65697439d33</cites><orcidid>0000-0002-2863-9389 ; 0000-0003-2215-9410 ; 0000-0002-1819-2464</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhep.31890$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhep.31890$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,315,781,785,886,1418,27926,27927,45576,45577</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33961298$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yip, Terry Cheuk‐Fung</creatorcontrib><creatorcontrib>Wong, Vincent Wai‐Sun</creatorcontrib><creatorcontrib>Lui, Grace Chung‐Yan</creatorcontrib><creatorcontrib>Chow, Viola Chi‐Ying</creatorcontrib><creatorcontrib>Tse, Yee‐Kit</creatorcontrib><creatorcontrib>Hui, Vicki Wing‐Ki</creatorcontrib><creatorcontrib>Liang, Lilian Yan</creatorcontrib><creatorcontrib>Chan, Henry Lik‐Yuen</creatorcontrib><creatorcontrib>Hui, David Shu‐Cheong</creatorcontrib><creatorcontrib>Wong, Grace Lai‐Hung</creatorcontrib><title>Current and Past Infections of HBV Do Not Increase Mortality in Patients With COVID‐19</title><title>Hepatology (Baltimore, Md.)</title><addtitle>Hepatology</addtitle><description>Background and Aims We compared risk of acute liver injury and mortality in patients with COVID‐19 and current, past, and no HBV infection. Approach and Results This was a territory‐wide retrospective cohort study in Hong Kong. Patients with COVID‐19 between January 23, 2020, and January 1, 2021, were identified. Patients with hepatitis C or no HBsAg results were excluded. The primary outcome was mortality. Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase ≥2 × upper limit of normal (ULN; i.e., 80 U/L), with total bilirubin ≥2 × ULN (i.e., 2.2 mg/dL) and/or international normalized ratio ≥1.7. Of 5,639 patients included, 353 (6.3%) and 359 (6.4%) had current and past HBV infection, respectively. Compared to patients without known HBV exposure, current HBV‐infected patients were older and more likely to have cirrhosis. Past HBV‐infected patients were the oldest, and more had diabetes and cardiovascular disease. At a median follow‐up of 14 (9‐20) days, 138 (2.4%) patients died; acute liver injury occurred in 58 (1.2%), 8 (2.3%), and 11 (3.1%) patients with no, current, and past HBV infection, respectively. Acute liver injury (adjusted HR [aHR], 2.45; 95% CI, 1.52‐3.96; P &lt; 0.001), but not current (aHR, 1.29; 95% CI, 0.61‐2.70; P = 0.507) or past (aHR, 0.90; 95% CI, 0.56‐1.46; P = 0.681) HBV infection, was associated with mortality. Use of corticosteroid, antifungal, ribavirin, or lopinavir–ritonavir (adjusted OR [aOR], 2.55‐5.63), but not current (aOR, 1.93; 95% CI, 0.88‐4.24; P = 0.102) or past (aOR, 1.25; 95% CI, 0.62‐2.55; P = 0.533) HBV infection, was associated with acute liver injury. Conclusion Current or past HBV infections were not associated with more liver injury and mortality in COVID‐19.</description><subject>Acute Lung Injury - blood</subject><subject>Acute Lung Injury - diagnosis</subject><subject>Acute Lung Injury - epidemiology</subject><subject>Acute Lung Injury - virology</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Alanine</subject><subject>Alanine Transaminase</subject><subject>Aspartate aminotransferase</subject><subject>Aspartate Aminotransferases</subject><subject>Bilirubin</subject><subject>Cardiovascular diseases</subject><subject>Cirrhosis</subject><subject>Corticosteroids</subject><subject>COVID-19</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - diagnosis</subject><subject>COVID-19 - mortality</subject><subject>COVID-19 - virology</subject><subject>Diabetes mellitus</subject><subject>Female</subject><subject>Hepatitis B surface antigen</subject><subject>Hepatitis B Surface Antigens - isolation &amp; purification</subject><subject>Hepatitis B virus - immunology</subject><subject>Hepatitis B virus - isolation &amp; purification</subject><subject>Hepatitis B, Chronic - complications</subject><subject>Hepatitis B, Chronic - diagnosis</subject><subject>Hepatitis B, Chronic - epidemiology</subject><subject>Hepatitis B, Chronic - virology</subject><subject>Hepatitis C</subject><subject>Hepatology</subject><subject>Hong Kong - epidemiology</subject><subject>Humans</subject><subject>Infections</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Lopinavir</subject><subject>Male</subject><subject>Medical History Taking - statistics &amp; numerical data</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original</subject><subject>Retrospective Studies</subject><subject>Ribavirin</subject><subject>Risk Assessment - statistics &amp; numerical data</subject><subject>Risk Factors</subject><subject>Ritonavir</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1uEzEURi0EomlhwQsgS2xgMa3t65_xBqmkhUQqtAso7CzHdoiryTjYM0XZ8Qg8I0-CS0oFSKzu4p579F19CD2h5JASwo5WYXMItNXkHppQwVQDIMh9NCFMkUZT0Htov5QrQojmrH2I9gC0pEy3E_RpOuYc-gHb3uMLWwY875fBDTH1Baclnr26xCcJv0s3C5eDLQG_TXmwXRy2OPb1Zoj1vuCPcVjh6fnl_OTHt-9UP0IPlrYr4fHtPEAfXp--n86as_M38-nxWeM4B9IITsXCC8fkggTCJJdu4VqhCFcgLSgvOTjFife64sFDK7wMUkitOGgPcIBe7rybcbEO3tUs2XZmk-Pa5q1JNpq_N31cmc_p2rQMdKtYFTy_FeT0ZQxlMOtYXOg624c0FsME4yAZpaKiz_5Br9KY-_pepZTQoKluK_ViR7mcSslheReGEnPTl6l9mV99Vfbpn-nvyN8FVeBoB3yNXdj-32Rmpxc75U89Ap1d</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Yip, Terry Cheuk‐Fung</creator><creator>Wong, Vincent Wai‐Sun</creator><creator>Lui, Grace Chung‐Yan</creator><creator>Chow, Viola Chi‐Ying</creator><creator>Tse, Yee‐Kit</creator><creator>Hui, Vicki Wing‐Ki</creator><creator>Liang, Lilian Yan</creator><creator>Chan, Henry Lik‐Yuen</creator><creator>Hui, David Shu‐Cheong</creator><creator>Wong, Grace Lai‐Hung</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2863-9389</orcidid><orcidid>https://orcid.org/0000-0003-2215-9410</orcidid><orcidid>https://orcid.org/0000-0002-1819-2464</orcidid></search><sort><creationdate>202110</creationdate><title>Current and Past Infections of HBV Do Not Increase Mortality in Patients With COVID‐19</title><author>Yip, Terry Cheuk‐Fung ; Wong, Vincent Wai‐Sun ; Lui, Grace Chung‐Yan ; Chow, Viola Chi‐Ying ; Tse, Yee‐Kit ; Hui, Vicki Wing‐Ki ; Liang, Lilian Yan ; Chan, Henry Lik‐Yuen ; Hui, David Shu‐Cheong ; Wong, Grace Lai‐Hung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4430-5415bd5c26b0e02646cbc85704736a37d643c740dd9430ed385d6e65697439d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Lung Injury - blood</topic><topic>Acute Lung Injury - diagnosis</topic><topic>Acute Lung Injury - epidemiology</topic><topic>Acute Lung Injury - virology</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Alanine</topic><topic>Alanine Transaminase</topic><topic>Aspartate aminotransferase</topic><topic>Aspartate Aminotransferases</topic><topic>Bilirubin</topic><topic>Cardiovascular diseases</topic><topic>Cirrhosis</topic><topic>Corticosteroids</topic><topic>COVID-19</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - diagnosis</topic><topic>COVID-19 - mortality</topic><topic>COVID-19 - virology</topic><topic>Diabetes mellitus</topic><topic>Female</topic><topic>Hepatitis B surface antigen</topic><topic>Hepatitis B Surface Antigens - isolation &amp; purification</topic><topic>Hepatitis B virus - immunology</topic><topic>Hepatitis B virus - isolation &amp; purification</topic><topic>Hepatitis B, Chronic - complications</topic><topic>Hepatitis B, Chronic - diagnosis</topic><topic>Hepatitis B, Chronic - epidemiology</topic><topic>Hepatitis B, Chronic - virology</topic><topic>Hepatitis C</topic><topic>Hepatology</topic><topic>Hong Kong - epidemiology</topic><topic>Humans</topic><topic>Infections</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Lopinavir</topic><topic>Male</topic><topic>Medical History Taking - statistics &amp; numerical data</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original</topic><topic>Retrospective Studies</topic><topic>Ribavirin</topic><topic>Risk Assessment - statistics &amp; numerical data</topic><topic>Risk Factors</topic><topic>Ritonavir</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yip, Terry Cheuk‐Fung</creatorcontrib><creatorcontrib>Wong, Vincent Wai‐Sun</creatorcontrib><creatorcontrib>Lui, Grace Chung‐Yan</creatorcontrib><creatorcontrib>Chow, Viola Chi‐Ying</creatorcontrib><creatorcontrib>Tse, Yee‐Kit</creatorcontrib><creatorcontrib>Hui, Vicki Wing‐Ki</creatorcontrib><creatorcontrib>Liang, Lilian Yan</creatorcontrib><creatorcontrib>Chan, Henry Lik‐Yuen</creatorcontrib><creatorcontrib>Hui, David Shu‐Cheong</creatorcontrib><creatorcontrib>Wong, Grace Lai‐Hung</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yip, Terry Cheuk‐Fung</au><au>Wong, Vincent Wai‐Sun</au><au>Lui, Grace Chung‐Yan</au><au>Chow, Viola Chi‐Ying</au><au>Tse, Yee‐Kit</au><au>Hui, Vicki Wing‐Ki</au><au>Liang, Lilian Yan</au><au>Chan, Henry Lik‐Yuen</au><au>Hui, David Shu‐Cheong</au><au>Wong, Grace Lai‐Hung</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Current and Past Infections of HBV Do Not Increase Mortality in Patients With COVID‐19</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><addtitle>Hepatology</addtitle><date>2021-10</date><risdate>2021</risdate><volume>74</volume><issue>4</issue><spage>1750</spage><epage>1765</epage><pages>1750-1765</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><abstract>Background and Aims We compared risk of acute liver injury and mortality in patients with COVID‐19 and current, past, and no HBV infection. Approach and Results This was a territory‐wide retrospective cohort study in Hong Kong. Patients with COVID‐19 between January 23, 2020, and January 1, 2021, were identified. Patients with hepatitis C or no HBsAg results were excluded. The primary outcome was mortality. Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase ≥2 × upper limit of normal (ULN; i.e., 80 U/L), with total bilirubin ≥2 × ULN (i.e., 2.2 mg/dL) and/or international normalized ratio ≥1.7. Of 5,639 patients included, 353 (6.3%) and 359 (6.4%) had current and past HBV infection, respectively. Compared to patients without known HBV exposure, current HBV‐infected patients were older and more likely to have cirrhosis. Past HBV‐infected patients were the oldest, and more had diabetes and cardiovascular disease. At a median follow‐up of 14 (9‐20) days, 138 (2.4%) patients died; acute liver injury occurred in 58 (1.2%), 8 (2.3%), and 11 (3.1%) patients with no, current, and past HBV infection, respectively. Acute liver injury (adjusted HR [aHR], 2.45; 95% CI, 1.52‐3.96; P &lt; 0.001), but not current (aHR, 1.29; 95% CI, 0.61‐2.70; P = 0.507) or past (aHR, 0.90; 95% CI, 0.56‐1.46; P = 0.681) HBV infection, was associated with mortality. Use of corticosteroid, antifungal, ribavirin, or lopinavir–ritonavir (adjusted OR [aOR], 2.55‐5.63), but not current (aOR, 1.93; 95% CI, 0.88‐4.24; P = 0.102) or past (aOR, 1.25; 95% CI, 0.62‐2.55; P = 0.533) HBV infection, was associated with acute liver injury. Conclusion Current or past HBV infections were not associated with more liver injury and mortality in COVID‐19.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33961298</pmid><doi>10.1002/hep.31890</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-2863-9389</orcidid><orcidid>https://orcid.org/0000-0003-2215-9410</orcidid><orcidid>https://orcid.org/0000-0002-1819-2464</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via Wiley Online Library
subjects Acute Lung Injury - blood
Acute Lung Injury - diagnosis
Acute Lung Injury - epidemiology
Acute Lung Injury - virology
Adult
Age Factors
Aged
Alanine
Alanine Transaminase
Aspartate aminotransferase
Aspartate Aminotransferases
Bilirubin
Cardiovascular diseases
Cirrhosis
Corticosteroids
COVID-19
COVID-19 - complications
COVID-19 - diagnosis
COVID-19 - mortality
COVID-19 - virology
Diabetes mellitus
Female
Hepatitis B surface antigen
Hepatitis B Surface Antigens - isolation & purification
Hepatitis B virus - immunology
Hepatitis B virus - isolation & purification
Hepatitis B, Chronic - complications
Hepatitis B, Chronic - diagnosis
Hepatitis B, Chronic - epidemiology
Hepatitis B, Chronic - virology
Hepatitis C
Hepatology
Hong Kong - epidemiology
Humans
Infections
Liver
Liver cirrhosis
Lopinavir
Male
Medical History Taking - statistics & numerical data
Middle Aged
Mortality
Original
Retrospective Studies
Ribavirin
Risk Assessment - statistics & numerical data
Risk Factors
Ritonavir
title Current and Past Infections of HBV Do Not Increase Mortality in Patients With COVID‐19
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