In a small study of patients with chronic hepatitis B virus (HBV) infection and coronavirus disease 2019 (COVID-19), researchers found that no patients with concomitant infection with both viruses progressed to a severe or critically ill status during hospitalization, but more than one-quarter had abnormal liver function tests on admission. Findings from this study were published in Clinical Gastroenterology and Hepatology.
The researchers enrolled 23 patients with COVID-19 and chronic HBV infection (mean age, 44.7±11.5 years) from 2 hospitals designated for COVID-19 care. Diagnosis of COVID-19 was confirmed by RT-PCR of RNA throat swab samples. HBV infection was confirmed by a positive test for hepatitis B surface antigen. Participants reported a history of HBV carrier status (n=6), a history of chronic hepatitis B (n=4), or no history of HBV infection (n=13). Lab tests found that 15 patients were HBV carriers, 7 had chronic hepatitis, and 1 patient had hepatitis B cirrhosis.
A total of 6 (26%) patients presented with liver test abnormalities on admission. Of these, 2 patients were hepatitis B virus carriers, 3 had chronic hepatitis B, and 1 had hepatitis B cirrhosis. Elevated levels of aspartate aminotransferase (AST [range, 44-277 U/L]), alanine transaminase (ALT [range, 52-575.1 U/L]), and total bilirubin (range, 17.5-309.18 μmol/L) were observed in 10 patients during hospitalization. All patients were treated with antiviral drugs, and 13 of these patients also received liver-protecting drugs. The entire cohort was discharged following treatment.
Patients with a history of hepatitis B/cirrhosis had a significantly higher mean activated partial thromboplastin time compared with patients who were HBV carriers (42.6 vs 29.0 seconds, respectively; P =.003). The median AST was also higher in patients with a history of hepatitis B/cirrhosis compared with HBV carriers (51.0 vs 22.0 U/L, respectively; P =.028). Additionally, patients with a history of hepatitis B/cirrhosis had a significantly higher median ALT (67.1 vs 23.4 H/L; P =.03), γ-glutamyle transpeptidase (48.4 vs 23.1 U/L; P =.024), total bilirubin (50.6 vs 10.2 μmol/L; P =.014), and direct bilirubin (29.8 vs 3.2 μmol/L; P =.014) compared with HBV carriers.
Although all patients who were admitted to the hospital had infections that were considered non-severe, 3 (13%) patients progressed to severe and 2 (8.7%) progressed to a critically ill statuses and were admitted to intensive care units (ICU). These severe and critically ill patients were all men, 3 of whom required mechanical ventilation. A patient in this severe/critically ill subgroup developed deep vein thrombosis during ICU treatment. Additionally, 2 severe/critically ill patients developed acute respiratory distress syndrome and another patient developed upper gastrointestinal hemorrhage, liver failure, and renal insufficiency. Liver function of these patients did not return to baseline prior to discharge.
Based on these findings, the investigators of this study wrote that they “recommend dynamic monitoring the liver function” of patients with COVID-19 and “liver test abnormalities on admission.”
Zhang B, Huang W, Zhang S. Clinical features and outcomes of coronavirus disease 2019 (COVID-19) patients with chronic Hepatitis B virus infection [published online June 14, 2020]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.06.011