Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Chronic hepatitis-C infection in COVID-19 patients is associated with in-hospital mortality
Diana Ronderos, Alaa Mabrouk Salem Omar, Hafsa Abbas, Jasbir Makker, Ahmed Baiomi, Haozhe Sun, Nikhitha Mantri, YongsuN Choi, Ked Fortuzi, Dongmin Shin, Harish Patel, Sridhar Chilimuri
Diana Ronderos, Haozhe Sun, Nikhitha Mantri, YongsuN Choi, Ked Fortuzi, Dongmin Shin, Sridhar Chilimuri, Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
Alaa Mabrouk Salem Omar, Department of Cardiology, Mount Sinai Morning Side, New York, NY 10023, United States
Hafsa Abbas, Jasbir Makker, Ahmed Baiomi, Harish Patel, Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
Author contributions: Ronderos D and Omar AMS, have conceptualization the study, performed data analysis and wrote the manuscript; Abbas H, Makker J, Baiomi A, Mantri N, Choi, Y, Fortzuri D and Shin D contributed to data buildup and manuscript write-up and Pate; Chilimuri SC did study supervision and assisted in Manuscript write-up and revision.
Institutional review board statement: The study was reviewed and approved by the BronxCare Hospital Center Institutional Review Board.
Informed consent statement: This was a retrospective study and consent forms is waived.
Conflict-of-interest statement: Authors have nothing to disclose.
Data sharing statement: No additional data are available.
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: Sridhar Chilimuri, MD, Chairman, Department of Internal Medicine, BronxCare Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, United States. chilimuri@bronxcare.org
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: May 2, 2021
Revised: May 20, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 16, 2021
BACKGROUND
There is little evidence about the association of pre-existing hepatitis C infection (HCV) with outcomes in patients with coronavirus disease 2019 (COVID-19).
AIM
To assess the prevalence of history of HCV among patients with COVID-19 and to study the relationship of in-hospital mortality in relation with other predictors of poor outcomes in the presence or absence of COVID-19 induced acute liver injury.
METHODS
In a retrospective single-center study design, 1193 patients with COVID-19 infection were studied. Patients were then classified into those with and without a history of HCV, 50 (4.1%) and 1157 (95.9%) respectively.
RESULTS
Multivariate cox-regression models showed that age, HCV, D-Dimer, and ferritin were the only predictors of in-hospital mortality. Acute liver injury and fibrosis score (Fib-4 score) were not different between both groups. Multivariate cox-regression model for liver profile revealed that aspartate aminotransferase/ alanine aminotransferase ratio, Fib-4 score, and HCV were predictors of in-hospital mortality. After propensity score matching HCV was the only predictor of mortality in the multivariate cox-regression model. A model including HCV was found to add predictive value to clinical and laboratory parameters.
CONCLUSION
In patients with COVID-19, history of HCV infection leads to an accentuated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virulence, irrespective of baseline comorbidities, admission laboratory variables, or COVID-19-induced liver injury, which may be related to extrahepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 viral entry, baseline cytokine-mediated pro-inflammation, and endothelial dysfunction.
Core Tip: In patients with coronavirus disease 2019 (COVID-19), history of hepatitis C infection accentuated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral virulence and is a strong predictor of in-hospital mortality irrespective of baseline comorbidities, laboratory parameters, or COVID-19-induced liver injury. History of hepatitis C infection (HCV) in these patients seems to add a cumulative mortality risk to any clinical or laboratory profile. The mechanisms involved may be related to extra hepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 virus and subsequent endothelial dysfunction. The realization is important for better characterization of the disease and triage this sub-group as high risk for therapeutic or prophylactic measures like vaccines.
