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. 2021 Aug 13;16(1):111–125. doi: 10.1007/s11684-021-0854-5

Clinical characteristics and risk factors of COVID-19 patients with chronic hepatitis B: a multi-center retrospective cohort study

Jing Wang 1,#, Zequn Lu 2,#, Meng Jin 3,#, Ying Wang 4,#, Kunming Tian 5,6,#, Jun Xiao 1,#, Yimin Cai 2,#, Yanan Wang 1,#, Xu Zhang 7, Tao Chen 8, Zhi Yao 9, Chunguang Yang 1, Renli Deng 10, Qiang Zhong 11, Xiongbo Deng 12, Xin Chen 13, Xiang-ping Yang 14, Gonghong Wei 15, Zhihua Wang 1,✉,#, Jianbo Tian 2,✉,#, Xiao-ping Chen 16,✉,#
PMCID: PMC8362646  PMID: 34387851

Abstract

The Coronavirus disease 2019 (COVID-19) has spread globally. Although mixed liver impairment has been reported in COVID-19 patients, the association of liver injury caused by specific subtype especially chronic hepatitis B (CHB) with COVID-19 has not been elucidated. In this multi-center, retrospective, and observational cohort study, 109 CHB and 327 non-CHB patients with COVID-19 were propensity score matched at an approximate ratio of 3:1 on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, disease severity, and clinical outcomes were compared. Furthermore, univariable and multivariable logistic and Cox regression models were used to explore the risk factors for disease severity and mortality, respectively. A higher proportion of CHB patients (30 of 109 (27.52%)) developed into severe status than non-CHB patients (17 of 327 (5.20%)). In addition to previously reported liver impairment markers, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin, we identified several novel risk factors including elevated lactate dehydrogenase (⩾ 245 U/L, hazard ratio (HR) = 8.639, 95% confidence interval (CI) = 2.528–29.523; P < 0.001) and coagulation-related biomarker D-dimer (⩾ 0.5 µg/mL, HR = 4.321, 95% CI = 1.443–12.939; P = 0.009) and decreased albumin (< 35 g/L, HR = 0.131, 95% CI = 0.048–0.361; P < 0.001) and albumin/globulin ratio (< 1.5, HR = 0.123, 95% CI = 0.017–0.918; P = 0.041). In conclusion, COVID-19 patients with CHB were more likely to develop into severe illness and die. The risk factors that we identified may be helpful for early clinical surveillance of critical progression.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at 10.1007/s11684-021-0854-5 and is accessible for authorized users.

Keywords: COVID-19, chronic hepatitis B, liver injury, coagulation dysfunction

Electronic supplementary material

Appendix (320.9KB, pdf)

Acknowledgements

We thank the assistance of Prof. David Home from CITY OF HOPE, Prof. Hui Zhu from Cleveland Clinic Foundation, and Prof. Jiping Wang from Northwestern University. This work is supported by the National Natural Science Foundation of China (No. 81974400) and Natural Science Foundation of Zhuhai (No. ZH22036302200081-PWC to Renli Deng). We acknowledge all patients and their families involved in the study and all health-care workers who are fighting against the COVID-19 pandemic.

Footnotes

Compliance with ethics guidelines

Jing Wang, Zequn Lu, Meng Jin, Ying Wang, Kunming Tian, Jun Xiao, Yimin Cai, Yanan Wang, Xu Zhang, Tao Chen, Zhi Yao, Chunguang Yang, Renli Deng, Qiang Zhong, Xiongbo Deng, Xin Chen, Xiang-ping Yang, Gonghong Wei, Zhihua Wang, Jianbo Tian, and Xiao-ping Chen declare that they have no conflict of interest. This study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and granted a waiver of informed consent from study participants.

These authors contributed equally as co-first authors.

These authors contributed equally as co-corresponding authors.

Contributor Information

Zhihua Wang, Email: zhwang_hust@hotmail.com.

Jianbo Tian, Email: tianjb@hust.edu.cn.

Xiao-ping Chen, Email: chenxpchenxp@163.com.

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Appendix (320.9KB, pdf)

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