Characteristics of Liver Function in Patients With SARS-CoV-2 and Chronic HBV Coinfection

Overview

Journal Clin Gastroenterol Hepatol

Specialty Gastroenterology

Date 2020 Jun 20

PMID 32553907

Citations 55

Authors

Xiaojing Zou

Minghao Fang

Shusheng Li

Liang Wu

Bing Gao

Hong Gao

Xiao Ran

Yi Bian

Renjie Li

ShanshanYu

Jianmin Ling

Donghui Li

Deying Tian

Jiao Huang

Affiliations

Soon will be listed here.

Abstract

Background & 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) coinfection.

Methods: We enrolled all adult patients with SARS-CoV-2 and chronic HBV coinfection 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 association with the severity and prognosis of disease were described.

Results: Of the 105 patients with SARS-CoV-2 and chronic HBV coinfection, elevated levels of liver test were observed 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 levels of the indicators mentioned above increased substantially during hospitalization (all P < .05). Fourteen (13.33%) patients developed liver injury. Most of them (10, 71.43%) recovered after 8 (range 6-21) days. Notably the other, 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 = .042). Complications including acute-on-chronic liver failure, acute cardiac injury and shock happened more frequently in patients with liver injury (all P < .05). The mortality was higher in individuals with liver injury (28.57% vs 3.30%, P = .004).

Conclusion: Liver injury in patients with SARS-CoV-2 and chronic HBV coinfection 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.

Citing Articles

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References

Zhang C, Shi L, Wang F . Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020; 5(5):428-430. PMC: 7129165. DOI: 10.1016/S2468-1253(20)30057-1. View

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J . Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. PMC: 7042881. DOI: 10.1001/jama.2020.1585. View

Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y . Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020; 71(15):762-768. PMC: 7108125. DOI: 10.1093/cid/ciaa248. View

Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J . Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020; 20(4):425-434. PMC: 7159053. DOI: 10.1016/S1473-3099(20)30086-4. View

Bertoletti A, Ferrari C . Adaptive immunity in HBV infection. J Hepatol. 2016; 64(1 Suppl):S71-S83. DOI: 10.1016/j.jhep.2016.01.026. View

Liu J, Liang W, Jing W, Liu M . Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019; 97(3):230-238. PMC: 6453311. DOI: 10.2471/BLT.18.219469. View

Ranieri V, Rubenfeld G, Thompson B, Ferguson N, Caldwell E, Fan E . Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. DOI: 10.1001/jama.2012.5669. View

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. PMC: 7159299. DOI: 10.1016/S0140-6736(20)30183-5. View

Terrault N, Lok A, McMahon B, Chang K, Hwang J, Jonas M . Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018; 67(4):1560-1599. PMC: 5975958. DOI: 10.1002/hep.29800. View

10.

Cai Q, Chen J . Reply to: "Clinical characteristics of COVID-19 patients with abnormal liver tests". J Hepatol. 2020; 73(3):713-714. PMC: 7201227. DOI: 10.1016/j.jhep.2020.04.042. View

11.

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C . Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4):420-422. PMC: 7164771. DOI: 10.1016/S2213-2600(20)30076-X. View

12.

Sarin S, Choudhury A, Sharma M, Maiwall R, Al Mahtab M, Rahman S . Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int. 2019; 13(4):353-390. PMC: 6728300. DOI: 10.1007/s12072-019-09946-3. View

13.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J . Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. PMC: 7092819. DOI: 10.1056/NEJMoa2002032. View

14.

Bangash M, Patel J, Parekh D . COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020; 5(6):529-530. PMC: 7270582. DOI: 10.1016/S2468-1253(20)30084-4. View

15.

Xu X, Wu X, Jiang X, Xu K, Ying L, Ma C . Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020; 368:m606. PMC: 7224340. DOI: 10.1136/bmj.m606. View

16.

Reddy K, Beavers K, Hammond S, Lim J, Falck-Ytter Y . American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2014; 148(1):215-9. DOI: 10.1053/j.gastro.2014.10.039. View

17.

Cottin J, Pierre S, Pizzoglio V, Simon C, Durrieu G, Bleyzac N . Methylprednisolone-related liver injury: A descriptive study using the French pharmacovigilance database. Clin Res Hepatol Gastroenterol. 2020; 44(5):662-673. DOI: 10.1016/j.clinre.2019.12.008. View

18.

. [The protocol for prevention, diagnosis and treatment of liver injury in coronavirus disease 2019]. Zhonghua Gan Zang Bing Za Zhi. 2020; 28(3):217-221. DOI: 10.3760/cma.j.cn501113-20200309-00095. View

19.

Meraviglia P, Schiavini M, Castagna A, Vigano P, Bini T, Landonio S . Lopinavir/ritonavir treatment in HIV antiretroviral-experienced patients: evaluation of risk factors for liver enzyme elevation. HIV Med. 2004; 5(5):334-43. DOI: 10.1111/j.1468-1293.2004.00232.x. View

20.

Tillmann H, Rockey D . Signatures in drug-induced liver injury. Curr Opin Gastroenterol. 2020; 36(3):199-205. PMC: 10896173. DOI: 10.1097/MOG.0000000000000636. View