Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2021; 27(42): 7362-7375
Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7362
Survival and outcomes for co-infection of chronic hepatitis C with and without cirrhosis and COVID-19: A multicenter retrospective study
Shimaa Afify, Basem Eysa, Fatma Abdel Hamid, Omnia M Abo-Elazm, Mohamed A Edris, Rabab Maher, Ahmed Abdelhalim, Muhammad Mostafa Abdel Ghaffar, Dalia A Omran, Hend Ibrahim Shousha
Shimaa Afify, Basem Eysa, Mohamed A Edris, Ahmed Abdelhalim, Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo 20222, Egypt
Fatma Abdel Hamid, Department of Endemic Medicine, Faculty of Medicine, Fayoum University, El-Fayoum 13524, Egypt
Omnia M Abo-Elazm, Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo 20222, Egypt
Rabab Maher, Department of Gastroenterology, Students Hospital, Cairo University, Giza 12111, Egypt
Muhammad Mostafa Abdel Ghaffar, The General Organization for Teaching Hospitals and Institutes, Cairo 11562, Egypt
Dalia A Omran, Hend Ibrahim Shousha, Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Afify S and Omran DA were the guarantors and designed the study; Afify S, Maher R, Eysa B, Abdel Ghaffar MM, Abdelhalim A and Edris MA participated in the acquisition of the data; Abo-Elazm OM participated in the analysis, and interpretation of the data; Shousha HI and Hamid FA drafted the initial manuscript; Afify S, Maher R, Omran DA, and Eysa B revised the article critically for important intellectual content.
Institutional review board statement: This study was approved by the research ethics committee of the General Organization for Teaching Hospitals and Institutes(number ITH00123) 22July 2020).
Informed consent statement: All study subjects gave written informed consent before study inclusion.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shimaa Afify, MD, MSc, PhD, Consultant Physician-Scientist, Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, 10 Fom Elkhalig, Kasr Alainy St., Cairo 20222, Egypt. drshima202@yahoo.com
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: April 29, 2021
Revised: May 12, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: November 14, 2021
Abstract
BACKGROUND

Chronic liver disease, particularly cirrhosis, is associated with worse outcomes in patients infected with coronavirus disease 2019 (COVID-19).

AIM

To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.

METHODS

This multicenter, retrospective cohort study included all cases of confirmed co-infection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals (Al-Sahel Hospital, Al-Matareya Hospital, Al-Ahrar Hospital, Ahmed Maher Teaching Hospital, Al-Gomhoreya Hospital, and the National Hepatology and Tropical Medicine Research Institute) affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt. Patients were recruited from May 1, 2020, to July 31, 2020. Demographic, laboratory, imaging features, and outcomes were collected. Multivariate regression analysis was performed to detect factors affecting mortality.

RESULTS

This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection, of which 64 (51.20%) had liver cirrhosis and 40 (32.00%) died. Fever, cough, dyspnea, and fatigue were the most frequent symptoms in patients with liver cirrhosis. Cough, sore throat, fatigue, myalgia, and diarrhea were significantly more common in patients with liver cirrhosis than in non-cirrhotic patients. There was no difference between patients with and without cirrhosis regarding comorbidities. Fifteen patients (23.40%) with liver cirrhosis presented with hepatic encephalopathy. Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans: 28 (43.75%) vs 4 (6.55%), respectively (P value < 0.001). These patients also were more likely to have severe COVID-19 infection, compared to patients without liver cirrhosis: 29 (45.31%) vs 11 (18.04%), respectively (P value < 0.003). Mortality was higher in patients with liver cirrhosis, compared to those with no cirrhosis: 33 (51.56%) vs 9 (14.75%), respectively (P value < 0.001). All patients in Child-Pugh class A recovered and were discharged. Cirrhotic mortality occurred among decompensated patients only. A multivariate regression analysis revealed the following independent factors affecting mortality: Male gender (OR 7.17, 95%CI: 2.19–23.51; P value = 0.001), diabetes mellitus (OR 4.03, 95%CI: 1.49–10.91; P value = 0.006), and liver cirrhosis (OR 1.103, 95%CI: 1.037–1.282; P value < 0.0001). We found no differences in liver function, COVID-19 disease severity, or outcomes between patients who previously received direct-acting antiviral therapy (and achieved sustained virological response) and patients who did not receive this therapy.

CONCLUSION

Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19. Male gender, diabetes mellitus, and liver cirrhosis are independent factors associated with increased mortality risk.

Keywords: COVID-19, Egypt, Outcome, Liver cirrhosis, Chronic hepatitis C

Core Tip: Chronic liver disease, particularly cirrhosis, is associated with worse outcomes in patients infected with coronavirus disease 2019 (COVID-19). This study examined the impact of COVID-19 infection on patients with chronic hepatitis C during the first COVID-19 peak in Egypt. This retrospective cohort study was performed in six Egyptian hospitals. We found that cirrhotic patients had higher rates of pneumonia, severe COVID-19, and mortality. Cirrhotic mortality was observed among decompensated patients only. Male gender, diabetes mellitus, and liver cirrhosis were independent factors associated with increased mortality risk in Egyptian patients with COVID-19 and chronic hepatitis C.