Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2021; 9(29): 8749-8762
Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8749
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
ARTICLE HIGHLIGHTS
Research background

The effect of preexisting chronic hepatitis C infection in coronavirus disease 2019 (COVID-19) patients has not been studied. Initial reports have suggested that COVID-19 patients with hepatitis C virus (HCV) are at increased risk for poor outcomes especially if accompanied by other risk factors such as advanced age and hypertension.

Research motivation

We have found that hepatitis C is associated with increased in-hospital mortality in patients hospitalized with COVID-19.

Research objectives

We aimed at assessing the relationship between in-hospital mortality with other predictors of poor outcomes in the presence or absence of baseline liver dysfunction or COVID-19 induced acute liver injury.

Research methods

We reviewed retrospectively the medical charts of patients with COVID-19 admission and the laboratory parameter in patients with and without history of HCV infection. Patients were then divided into two groups based on the presence or absence of a history of HCV and their demographic, clinical, laboratory variables, and outcomes were compared. The primary endpoint of our study was in-hospital mortality.

Research results

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. 2-log likelihood ratio was done to compare different diagnostic models and it was found that a model including HCV add a predictive value to clinical and laboratory parameters.

Research conclusions

HCV infection accentuated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral virulence in our study and had a strong association with in-hospital mortality irrespective of baseline co-morbidities, admission laboratory variables, or COVID-19-induced liver injury. The mechanisms involved may be related to extra-hepatic effects of HCV, baseline cytokine-mediated pro-inflammation, and endothelial dysfunction. Understanding of these mechanisms may help in better characterization of the disease and investigating possible therapeutic options in this subgroup of patients.

Research perspectives

COVID-19 is significantly heterogeneous. Predictors of Mortality are numerous and association of baseline risk and co-morbidities are still developing. Based on an observation of HCV association with increased risk in our institution we sought to investigate the relationship between HCV and COVID-19 mortality