Patients with both COVID-19 and HBV had a significantly higher in-hospital mortality rate and were more likely to develop severe disease compared to patients with only COVID-19 infections.
With negative outcomes and mortality more likely to occur in patients with COVID-19 and hepatitis B virus (HBV) infections, more attention should be paid to this patient population.
A team, led by Yang Yu, Department of Hepatobiliary and Pancreatic Surgery, China-Japan Union Hospital of Jilin University, identified the effects of HBV infections on patients with COVID-19.
Recent research has shown liver enzyme abnormalities are the most common clinical feature in patients with COVID-19, occurring in about 50% of patients.
This also means patients with liver disease are a high-risk group for COVID-19, including patients with chronic liver disease.
HBV continues to be a major public concern, with approximately 300 million individuals globally infected.
“Studies have confirmed that HBV infection can lead to an impaired innate immune response and an imbalanced acquired immune response,” the authors wrote. “Moreover, the uncontrolled innate response and impaired acquired immune response caused by SARS-CoV-2 may lead to local and systemic deleterious tissue damage. Therefore, mixed infection with SARS-CoV-2 and fHBV may aggravate immune function and liver damage.”
Initial studies report between 0-1.3% of patients with COVID-19 also have an HBV infection.
However, these studies often contain different definitions of liver abnormalities and liver injuries, making it difficult to make comparisons between studies.
In the meta-analysis, the investigators searched various databases for studies regarding patients with HBV and COVID-19 coinfections and identified 37,696 total patients from 2932 studies in mainland China, Hong Kong, Korea, and Turkey.
The patient population was split between patients with both COVID-19 and HBV infections (n = 2591) and patients with COVID-19, but no HBV infection (n = 35,105). After eliminating duplicates, comments, revises, case reports, and papers with insufficient data or overlapping patients, the investigators included 13 total studies in the final analysis.
The results show the co-infection group had a significantly higher in-hospital mortality compared to the control group (OR, 2.04; 95% CI, 1.49–2.79; , I2 = 42.1%; P <0.001) and were also more likely to develop severe disease (OR, 1.90; 95% CI, 1.32–2.73; I2 = 48.5%; P <0.001).
The investigators also measured alanine aminotransferase (SMD, 0.62; 95% CI 0.25–0.98; I2 = 96.6%; P <0.001), aspartate aminotransferase (SMD, 0.60; 95% CI, 0.30–0.91; I2 = 95.0%; P <0.001), total bilirubin (SMD, 0.45; 95% CI, 0.23–0.67; I2 = 87.4%; P <0.001), direct bilirubin (SMD, 0.36; 95% CI, 0.24–0.47; I2 = 19.1%; P <0.001), lactate dehydrogenase (SMD, 0.32; 95% CI, 0.18–0.47; I2 = 48.3%; P <0.001).
This resulted in the discovery that HBV infections contribute to significantly higher laboratory results in patients with COVID-19.
“Our study showed that COVID-19 patients infected with HBV were more likely to develop severe disease and might have more severe liver function abnormalities than COVID-19 patients not infected with HBV,” the authors wrote. “COVID-19 patients infected with HBV should receive more attention, and special attention should be paid to various liver function indices during treatment.”
The study, “Effects of Hepatitis B Virus Infection on Patients with COVID-19: A Meta-Analysis,” was published online in Digestive Diseases and Sciences.