Liver dysfunction and clinical outcomes of unvaccinated COVID-19 patients with and without chronic hepatitis B

Abstract

Background: Liver dysfunction is common during coronavirus disease 2019 (COVID- 19), while its clinical impact and association with chronic hepatitis B (CHB) remain uncertain. We aimed to investigate liver dysfunction in COVID-19 patients and its impacts on those with/ without CHB. Methods: We conducted a retrospective cohort study of COVID-19 patients at National Taiwan University Hospital, stratified according to hepatitis B surface antigen (HBsAg) serostatus, with demographics, laboratory data, and hospitalization course reviewed, and clinical outcomes compared through multivariable analyses. Results: We enrolled 109 COVID-19 patients unvaccinated against SARS-CoV-2 by August 2021. The HBsAg-positive group (n Z 34) had significantly higher alanine aminotransferase (ALT) (26 vs. 16 U/L, P Z 0.034), platelet (224 vs. 183 k/mL, P Z 0.010) and longer hospitalizations (17 vs. 13 days, PZ0.012) compared with HBsAg-negative group (nZ75), while percentages of hepatitis (2-fold ALT elevation), oxygen supplementation, ventilators usage, COVID-specific treatment, intensive care unit (ICU) admission and mortality were comparable. Older age (odds ratio [OR]: 1.04, 95 % confidence interval [CI]: 1.00e1.08, PZ0.032) and higher aspartate aminotransferase (AST) (OR: 1.08, 95 % CI: 1.004e1.16, PZ0.038) were associated with oxygen supplementation according to multivariable analyses. Higher AST predicted ICU admission (OR: 1.11, 95 % CI: 1.03e1.19, P Z 0.008). Oxygen usage (OR: 5.64, 95 % CI: 1.67e19.09, P Z 0.005) and shock (OR: 5.12, 95 % CI: 1.14e22.91, P Z0.033) were associated with liver dysfunction. Conclusions: CHB patients had higher ALT levels and longer hospitalizations during COVID-19. Higher AST levels predict severe COVID-19 and ICU admission.