Letter to the Editor
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5831-5834
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5831
Is positivity for hepatitis C virus antibody predictive of lower risk of death in COVID-19 patients with cirrhosis?
Alessandra Mangia, Giovanni Cenderello, Gabriella Verucchi, Alessia Ciancio, Andrea Fontana, Valeria Piazzolla, Nicola Minerva, Maria Maddalena Squillante, Massimiliano Copetti
Alessandra Mangia, Valeria Piazzolla, Maria Maddalena Squillante, Liver Unit, Department of Medical Sciences, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo 71013, Italy
Giovanni Cenderello, Department of Infectious Disease, ASL1 Imperiese, Sanremo 18038, Italy
Gabriella Verucchi, Department of Infectious Disease, University of Bologna, Bologna 40138, Italy
Alessia Ciancio, Department of Gastroenterology, University of Turin, Torino 10156, Italy
Andrea Fontana, Massimiliano Copetti, Department of Biostatistics, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo 71013, Italy
Nicola Minerva, Department of Internal Medicine, Ospedale Bonomo, Andria 76123, Italy
Author contributions: Mangia A designed the study; Mangia A, Fontana A and Copetti M performed the data analysis and wrote the manuscript; Ciancio A, Verucchi G, Cenderello G, Minerva N and Piazzolla V collected the data and revised the manuscript for important intellectual content.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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: Alessandra Mangia, MD, Liver Unit, Department of Medical Sciences, Fondazione IRCCS “Casa Sollievo della Sofferenza”, viale Cappuccini, 1, San Giovanni Rotondo 71013, Italy. a.mangia@tin.it
Received: September 11, 2020
Peer-review started: September 11, 2020
First decision: September 29, 2020
Revised: October 1, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: November 26, 2020
Abstract

Liver injury has been reported in coronavirus disease 2019 (COVID-19) cases but the impact of pre-existing liver damage and related etiology have not been completely elucidated. Our research interests include the potential reciprocal influence of COVID-19 and pre-existing liver damage related to hepatitis C virus (HCV) infection, in particular. To this end, we have evaluated three cohorts of patients admitted at three Italian hospitals during the coronavirus pandemic; these included 332 patients with COVID-19 and 1527 patients with HCV who were from established real-world antiviral treatment study cohorts (sofosbuvir/velpatasvir), with either liver disease (various severities; n = 1319) or cirrhosis (n = 208). Among the COVID-19 patients, 10 had cirrhosis (3%), including 7 of metabolic origin and 3 of viral origin. Mortality among the COVID-19 patients was 27.1%, with 70% of those with cirrhosis of metabolic etiology having died. Cirrhosis, older age, low white blood cell count and lymphocyte count being identified as risk predictors of death [odds ratio (OR) = 13.7, 95% confidence interval (CI): 2.59-83.01, P = 0.006; OR = 1.05, 95%CI: 1.03-1.08, P = 0.0001; OR = 1.09, 95%CI: 1.36-1.16, P = 0.001; OR = 0.61, 95%CI: 0.39-0.93, P = 0.023, respectively]. In the two cohorts of HCV patients, COVID-19 diagnosis was made in 0.07% of those with liver disease and 1% of those with cirrhosis. Thus, the prevalence of HCV antibodies among COVID-19-infected patients was comparable to that currently reported for the general population in Italy. Amongst the COVID-19 patients, pre-existing metabolic cirrhosis appears to be associated with higher mortality, while HCV antibodies may be suggestive of “protection” against COVID-19.

Keywords: Hepatitis C virus, Hepatitis B virus, Cirrhosis, COVID-19, Sofosbuvir, Velpatasvir

Core Tip: This ongoing study aims to investigate the potential reciprocal influence of coronavirus disease 2019 (COVID-19) and pre-existing cirrhosis. To date, it has included 332 patients with COVID-19 admitted to three Italian hospitals during the current pandemic, as well as two large cohorts of hepatitis C virus (HCV) patients from real-world antiviral treatment (pangenotypic sofosbuvir/velpatasvir combination) studies. Despite the limited COVID-19 sample size, cirrhosis was found to be associated with higher mortality, with the majority of deaths related to cirrhosis of metabolic origin. The very low prevalence of COVID-19 in the HCV cohorts supports a possible protective role of HCV antibodies.