COVID-19 in patients with hepatobiliary and pancreatic diseases: a single-centre cross-sectional study in East London

Abstract

Objective: To explore risk factors associated with COVID-19 susceptibility and survival in patients with pre-existing hepato-pancreato-biliary (HPB) conditions.

Design: Cross-sectional study.

Setting: East London Pancreatic Cancer Epidemiology (EL-PaC-Epidem) Study at Barts Health National Health Service Trust, UK. Linked electronic health records were interrogated on a cohort of participants (age ≥18 years), reported with HPB conditions between 1 April 2008 and 6 March 2020.

Participants: EL-PaC-Epidem Study participants, alive on 12 February 2020, and living in East London within the previous 6 months (n=15 440). The cohort represents a multi-ethnic population with 51.7% belonging to the non-White background.

Main outcome measure: COVID-19 incidence and mortality.

Results: Some 226 (1.5%) participants had confirmed COVID-19 diagnosis between 12 February and 12 June 2020, with increased odds for men (OR 1.56; 95% CI 1.2 to 2.04) and Black ethnicity (2.04; 1.39 to 2.95) as well as patients with moderate to severe liver disease (2.2; 1.35 to 3.59). Each additional comorbidity increased the odds of infection by 62%. Substance misusers were at more risk of infection, so were patients on vitamin D treatment. The higher ORs in patients with chronic pancreatic or mild liver conditions, age >70, and a history of smoking or obesity were due to coexisting comorbidities. Increased odds of death were observed for men (3.54; 1.68 to 7.85) and Black ethnicity (3.77; 1.38 to 10.7). Patients having respiratory complications from COVID-19 without a history of chronic respiratory disease also had higher odds of death (5.77; 1.75 to 19).

Conclusions: In this large population-based study of patients with HPB conditions, men, Black ethnicity, pre-existing moderate to severe liver conditions, six common medical multimorbidities, substance misuse and a history of vitamin D treatment independently posed higher odds of acquiring COVID-19 compared with their respective counterparts. The odds of death were significantly high for men and Black people.

Keywords: COVID-19; hepatobiliary disease; pancreatic disease.

Figure 1

Selection of patients for the cross-sectional study. EHR, electronic health record; EL-PaC-Epidem, East London Pancreatic Cancer Epidemiology; GP, general practitioner; HPB, hepato–pancreato–biliary.

Figure 2

OR estimates of COVID-19 for patients with HPB diseases with specific demographic, comorbidity, lifestyle and medication use characteristics. OR estimates for demographic characteristics are mutually controlled for each other, that is, gender, ethnicity and age group. Estimates for HPB disease subgroups are further controlled for each other. For comorbidity, lifestyle and medication use characteristics, estimates are controlled for gender, ethnicity and dichotomous age group (under and over 60 years). HPB, hepato–pancreato–biliary; NSAID, non-steroidal anti-inflammatory drug.

Figure 3

OR estimates of COVID-19-related death for patients with HPB diseases with specific demographic, comorbidity, lifestyle, medication use and post-COVID-19 diagnosis complication characteristics. OR estimates for demographic characteristics are mutually controlled for each other, that is, gender, ethnicity and age group. Estimates for HPB disease subgroups are further controlled for each other. For comorbidity, lifestyle, medication use and post-diagnosis complication characteristics, estimates are controlled for gender, ethnicity and dichotomous age group (under and over 60 years). Categories with OR p>0.95 are not shown. HPB, hepato–pancreato–biliary; NSAID, non-steroidal anti-inflammatory drug.