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

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 < 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.

FIG. 1

Selection of patients with SARS‐CoV‐2 infection/COVID‐19.

FIG. 2

Serial (A) ALT, (B) total bilirubin, and (C) ALP of patients with SARS‐CoV‐2 infection/COVID‐19 who had no HBV infection, who had current HBV infection, or who had past HBV infection.

FIG. 3

Cumulative incidence of mortality after PS weighting in patients with SARS‐CoV‐2 infection/COVID‐19 who had no HBV infection, who had current HBV infection, or who had past HBV infection in a single multiple imputation data set.