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:
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.
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
Research background

Coronavirus disease 2019 (COVID-19) disease severity and outcomes are affected by pre-existing chronic liver disease, particularly cirrhosis. Patients with decompensated liver cirrhosis (Child-Pugh classes B and C) are severely affected, with higher mortality rates than patients with compensated disease.

Research motivation

Comprehensive research on the outcome of COVID-19 in patients with isolated etiology of pre-existing chronic liver disease is needed to understand the clinical presentations and outcomes.

Research objectives

This study aimed to demonstrate the impact of COVID-19 factors affecting mortality among patients with pre-existing hepatitis C with or without liver cirrhosis during the first peak of the pandemic in Egypt.

Research methods

This multicenter retrospective cohort study included 125 patients with COVID-19 at six quarantine hospitals in Egypt from May 1, 2020, to July 31, 2020. Clinical, laboratory features, COVID-19 severity, and outcomes were recorded. A regression analysis was performed to detect factors affecting mortality.

Research results

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. Fifteen (23.4%) patients with liver cirrhosis presented with hepatic encephalopathy. Patients with liver cirrhosis were more likely to exhibit combined ground-glass opacities and consolidations in their chest CT scans and more likely to present with severe COVID-19 infection, compared to patients without liver cirrhosis. Mortality was higher among patients with liver cirrhosis: 33 (51.56%) vs 9 (14.75%), respectively (P value < 0.001. All patients in Child-Pugh class A recovered and were discharged, and mortalities occurred among patients in Child-Pugh classes B and C. A multivariate logistic regression revealed that male gender, diabetes mellitus, and liver cirrhosis were independent factors affecting mortality. Regarding liver function, COVID-19 disease severity, and outcomes, we found no difference between patients who previously received direct acting antiviral therapy (and achieved sustained virological response) and patients who did not receive such therapy.

Research conclusions

Patients with decompensated hepatitis C virus-related liver cirrhosis are at higher risk of severe COVID-19 disease and mortality. Male gender, diabetes mellitus, and liver cirrhosis are the independent factors affecting mortality.

Research perspectives

Male gender, diabetes mellitus, and liver cirrhosis significantly increased mortality in patients with COVID-19 and isolated hepatitis C virus-related chronic liver disease. Previous achievement of sustained virological response after direct acting antiviral therapy for chronic hepatitis C does not impact COVID-19 disease severity, outcome, or the results of liver function tests.