Epidemiological and Clinical Characteristics of 70 Cases of Coronavirus Disease and Concomitant Hepatitis B Virus Infection

A Multicentre Descriptive Study

Jian Wu; Jiong Yu; Xiaowei Shi; Wei Li; Shu Song; Liangping Zhao; Xinguo Zhao; Jun Liu; Dawei Wang; Chengyuan Liu; Biao Huang; Yiling Meng; Bin Jiang; Yijun Deng; Hongcui Cao; Lanjuan Li

Disclosures

J Viral Hepat. 2020;28(1):80-88. 

In This Article

Results

Demographic, Baseline, and Clinical Characteristics

In this study, we enrolled 620 patients with COVID-19 from 7 hospitals in the provinces of Jiangsu, Hubai, Anhui, and Zhejiang, 70 of whom had concomitant HBV infection. Table 1 shows the demographic, baseline and clinical characteristics of all recruited cases.

There were no significant differences in either age or sex between the CHI and WHI groups (both P > .05). In the CHI group, 28 patients (40.00%) were female, with a median age of 51 years. Their distribution according to age was as follows: under 18 years, n = 4 (5.71%); 18–24 years, n = 2 (2.86%); 25–49 years, n = 25 (35.71%); 50–64 years, n = 28 (40%); and over 65 years, n = 11 (15.71%). In terms of agglomerative epidemiology, the proportion of Generation I patients in the WHI group was significantly higher than that in the CHI group (31.82% vs. 17.14%, P = .012), while the proportion of Generation IV patients in the CHI group was significantly higher than that in the WHI group (31.43% vs. 10.18%, P = .000). The proportion of patients in the severe/critically ill subgroup in the CHI group was higher than that in the WHI group (32.86% vs. 15.27%, P = .000).

Fever and cough were the main symptoms in both the groups, and the proportion of patients with these symptoms showed no significant differences between groups. However, compared with the WHI group, patients in the CHI group demonstrated a higher frequency of gastrointestinal symptoms (8.57% vs. 0.91%, P = .000).

Laboratory and Imaging Abnormalities

The laboratory results of all recruited patients are summarized in Table 2. Among all the included parameters, only alanine aminotransferase (ALT), aspartate transaminase (AST) and activated partial thromboplastin (APTT) levels were significantly higher in the CHI group than in the WHI group [50 (28–69 vs. 21 (14–30), P = .000; 40 (25–54) vs. 23 (18–30), P = .000; 34.0 (27.2–38.7) vs. 37.2 (31.1–41.4), P = .031, respectively]. Of the 70 patients in the CHI group, 28 patients (40%) had a white blood cell (WBC) count lower than normal, 22 patients (31.43%) had a lymphocyte count lower than normal, and 18 patients (25.71%) had a platelet (PLT) count lower than normal (125 × 109/L). The level of C-reactive protein (CRP) was elevated in 62 patients (88.57%).

Blood biochemical examination showed that 36 patients (51.43%) had abnormal ALT and/or AST levels, and 18 patients (25.71%) had an albumin (ALB) level lower than the normal range (35 g/L). Only one patient (1.43%) showed renal function impairment. There were 12 patients (17.14%) with high creatine kinase (CK) and 11 patients (15.71%) with high lactate dehydrogenase (LDH). Lastly, 15 patients (21.43%) had blood glucose levels (GLU) above the normal range (5.9 mmol/L), and 15 (21.43%) patients showed abnormal coagulation function.

Regarding imaging features, there were no significant differences between groups. In the CHI group, 49 patients (70.00%) showed bilateral pneumonia, 13 patients (18.57%) had unilateral pneumonia, and 8 patients (11.43%) did not show any abnormal density shadows in the parenchyma of both lungs (Table 1).

Treatment for Patients With Coronavirus Disease With Concomitant Hepatitis B Virus Infection

All patients were recommended for timely antiviral therapy. Coriolus, Arbidol, chloroquine phosphate and reconstituted human interferon alfa-2b injection were the primary antiviral drugs used. Compared with the WHI group, the utilization rate of Arbidol was significantly higher (48.57% vs. 35.64%, P < .05; Figure 2A) in the CHI group, while the utilization rates of coriolus and chloroquine phosphate were lower (44.29% vs. 51.27%, P > .05; 1.43% vs. 14.00%, P < .05; Figure 2A) in the CHI group. There was no statistical difference for the utilization rate of reconstituted human interferon alfa-2b injection (58.57% vs. 63.27%, P > .05; Figure 2A) between the two groups. In contrast, 120 patients (21.82%) in the WHI group and 13 patients (18.57%) in the CHI group received methylprednisolone sodium succinate or methylprednisolone (P > .05; Figure 2B),.

Figure 2.

Comparison of treatment and outcome between WHI group and CHI group. A, The utilization rate of Coriolus, Arbidol, chloroquine phosphate, and reconstituted human interferon alfa-2b injection in two groups; (B) The utilization rate of immunoglobulin, hormone, non-invasive ventilator and invasive ventilator in two groups; (C) The average stay and the time of nucleic acid turning negative in two groups. WHI, COVID-19 without HBV infection; CHI, COVID-19 combined with HBV infection

Moreover, the utilization rate of immunoglobulin in the CHI group was significantly higher than in the WHI group (21.43% vs. 8.18%, P < .001; Figure 2B). In contrast, 212 patients (38.55%) in the WHI group and 39 patients (55.71%) in the CHI group were managed with non-invasive ventilation (ie with a face mask) (P < .05; Figure 2B). The utilization rate of invasive ventilator in the CHI group was higher (11.43% vs. 5.64%, P > .05; Figure 2B) than in the CHI group.

Clinical Outcomes of Patients With Coronavirus Disease and Concomitant Hepatitis B Virus Infection

In terms of outcome, all patients in the CHI group recovered and were discharged from the hospital, while in the WHI group, 14 patients (2.55%) died and 536 patients (97.45%) recovered and were discharged (Table 1). To further compare the clinical outcomes between the two groups, we evaluated the average hospital stay of patients and the time of nucleic acid testing turning negative in 606 patients. The average stay of patients in the CHI group was 15.86 days, which was similar to that in the WHI group (15.86 vs. 15.65, P > .05; Figure 2C). The time of nucleic acid testing turning negative in the CHI group was also similar to that in the WHI group (12.08 vs. 12.63, P > .05; Figure 2C).

Risk Factors for Delayed the Recovery of Patients With Coronavirus Disease and Concomitant Hepatitis B Virus Infection

In this study, we defined the time of recovery of patients with COVID-19 and concomitant HBV infection as the time from the first positive nucleic acid test result to the first negative nucleic acid test result after treatment. We investigated the risk factors for delayed recovery of 70 patients with COVID-19 and concomitant HBV infection.

A univariate Cox analysis was initially performed to evaluate the association of clinical and laboratory parameters with the time of recovery of patients with COVID-19 and concomitant HBV infection, which indicated that age, lymphocyte, aspartate transaminase, albumin, lactate dehydrogenase, creatine kinase and CRP were all risk factors for delayed recovery of patients with COVID-19 and concomitant HBV infection. Of note, neither elevated ALT nor elevated HBsAg levels were risk factors for delayed recovery. Subsequently, multivariate analyses further demonstrated that increasing age and elevated CRP level were both independent risk factors for delayed recovery of patients with COVID-19 and concomitant HBV infection (Table 3).

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