Clinical aspect of coronavirus disease 2019 (COIVD-19) on HBV infected patients in term of Health Insurance Review and Assessment service data

초록

Background and aims: Several reports announced chronic liver diseases and cirrhosis are risk factors for COVID (coronavirus disease)-19 infection and poor outcomes. However, there is no large data to report the specific clinical course of COVID-19 patients with chronic hepatitis B virus (HBV) infection. In this study, we aimed to report the clinical course of COVID-19 patients with HBV infection, to provide a reference for clinical treatment of the patients, and also to know whether the use of antiviral agents affects the clinical course. Method: We performed a nationwide population-based cohort study using the Korean Health Insurance Review and Assessment database. Claim records were screened for 19, 160 individuals who were diagnosed by the test of COVID-19 until November 2020. Results: Of the 19, 160 patients diagnosed with COVID-19, 675 (3.5%) patients had HBV infection. Among them, 138 (20.4%) patients were receiving antiviral therapy for the purpose of treating hepatitis B. The Mean age was 52.6 years for COVID-19 infection patients and 59.3 years for HBV infected patients; the HBV infected patients were elderly and showed higher rates of concomitant diseases such as diabetes, hypertension, and lung diseases compared with non-HBV infected patients (p < 0.001). During the observation period (about 10 months), 1, 524 (8.2%) of overall COVID-19 patients died and 91 HBV-infected patients (13.5%) died of COVID-19 disease ( p < 0.001). For 675 HBV-infected patients, the mean hospital stay was 19.9 days; of whom 85 patients (12.6%) were admitted to the intensive care unit, 13 patients (1.9%) had liver failure, 54 patients (8%) had acute respiratory failure, and 34 (5%) patients showed acute renal failure. When the overall risk of mortality was assessed for HBV-infected patients with antiviral drugs and without the antiviral drug, the Crude odds ratio (OR) was 1.72 (95% confidence interval (CI), 1.39–2.11), P < 0.001) and 1.96 (95%CI, 1.30–2.87; p = 0.001), respectively; which showed that the HBV-infected patients with or without the antiviral treatment had a higher risk of death when exposed to COVID-19. However, after age, sex, and comorbid diseases were corrected, the adjusted OR was 0.97 (95% CI, 0.76–1.23; p = 0.823) and 1.01 (95% CI, 0.63–1.59; p = 0.952), respectively, and these indicated no difference in mortality risk compared to other patients. In addition, there was no difference in intensive care unit admission rate or hospital stay length after correction. Conclusion: In COVID-19 infected patients with chronic liver diseases or cirrhosis caused by HBV infection, they showed a slightly higher mortality rate than those without the diseases. However, In the case of patients treated with the antiviral agent for HBV infection, it can be seen that their mortality rate from COVID-19 does not increase further if there is no cirrhosis or other comorbidity.