Study reveals link between cirrhosis and increased COVID-19 mortality

Data from a retrospective analysis of information from the Nationwide Inpatient Sample provide clinicians with an overview of the risk of COVID-19-related death in patients with hepatitis C.

The study’s results, which include data on more than 1 million hospitalizations due to COVID-19, suggest that hepatitis C virus is not directly associated with an increased risk of death, but that the presence of hepatitis C and cirrhosis is associated with an increased risk of death.

“Although cirrhosis increases mortality in patients hospitalized with COVID-19, HCV does not appear to be a risk factor for COVID-19-related death in the absence of cirrhosis,” the researchers wrote.

Although World Health Organization Director-General Tedros Adhanom Ghebreyesus announced on May 5, 2023 that the COVID-19 pandemic is no longer considered a public health emergency, it is expected to remain a prominent focus of academic research for decades to come.² Now, several years after the peak of the pandemic and with more comprehensive data, researchers can gain a deeper understanding of the impact of comorbidities on the risk of death in COVID-19 patients.

In the current study, Dr. Jose Debes, associate professor of medicine in the Department of Infectious Diseases and International Medicine at the University of Minnesota, and Dr. Spencer Goble, a resident physician at Hennepin County Medical Center, sought to understand whether a history of hepatitis C virus infection is associated with negative outcomes in patients hospitalized with COVID-19. The results are relevant. With this in mind, the pair designed their research effort to analyze data recorded in the 2020 National Inpatient Sample.

For the analysis, the researchers used ICD-10 codes for primary diagnosis of COVID-19 and identified patients with a history of HCV infection, including documented chronic infection, acute infection, and HCV carriers. The researchers noted that their study did not include data related to HCV treatment. Outcomes of interest for the study included differences in mortality, length of stay and total hospital charges between patients with and without a history of HCV, using logistic regression and adjusting for age, sex and Charlson Comorbidity index was used to assess these outcomes.

Overall, researchers identified 1,050,720 hospitalized adults with a primary diagnosis of COVID-19 during 2020. Of these, 8040 were secondary diagnosed with HCV infection. Preliminary analysis showed that people with a history of HCV were younger (mean age 62.1 vs 64.8 years; ask <.001), more likely to be male (68.2% vs 52.9%, P.001), black (35.2% vs 18.3%, P <.001), with a higher burden of comorbidities.

Analysis of the results showed mortality (odds ratio (OR), 1.04; 95% confidence interval (CI), 0.90-1.22; ask = .549) and intubation (OR, 1.14; 95% CI, 0.98-1.33; ask=.092) showed an increasing trend in the number of patients with a positive history of HCV after adjusting for confounders, but the researchers noted that the observed difference was not statistically significant. Additional analyzes restricting the HCV cohort to patients with cirrhosis showed that these patients were at increased risk of death (adjusted OR, 1.42; 95% CI, 1.05-1.91; ask=.023). The researchers also drew attention to results showing that a history of hepatitis C virus infection was associated with increased length of hospital stay (ask=.04), but hospital costs did not increase (ask=.64).

“Our study suggests that no special precautions or differentiated treatment are needed in patients with HCV but without cirrhosis,” the researchers wrote.

refer to:

1. Goble S, you must JD. Hepatitis C virus infection and mortality in hospitalized patients with COVID-19. Published at: AASLD Liver Meeting, November 10-14, 2023. Accessed: November 21, 2023.
2. Burki T. WHO ends COVID-19 public health emergency. Lancet Respiratory Medicine. 2023;11(7):588. Number: 10.1016/S2213-2600(23)00217-5