key: cord-0874618-5pfusktn authors: Chen, Xiaoping; Jiang, Qunqun; Ma, Zhiyong; Ling, Jiaxin; Hu, Wenjia; Cao, Qian; Mo, Pingzheng; Yang, Rongrong; Gao, Shicheng; Gui, Xien; Xiong, Yong; Li, Jinlin; Zhang, Yongxi title: Clinical Characteristics of Hospitalized Patients with SARS-CoV-2 and Hepatitis B virus Co-infection date: 2020-03-27 journal: nan DOI: 10.1101/2020.03.23.20040733 sha: f729b8142b6706f75d7ad9bec583b3591d01b996 doc_id: 874618 cord_uid: 5pfusktn Background & Aims The coronavirus disease 2019 (COIVD-19) caused by SARS-CoV-2 has been characterized as a pandemic, which causes a serious public health challenge in the world. A very large group of patients infected by HBV has been reported worldwide, especially in China. In order to answer whether specific treatment strategy on the patients coinfected with HBV and SARS-CoV-2, it requires profound understanding of the clinical characteristics on those patients. However, the impacts of SARS-CoV-2 infection on HBV patients remain largely unknown. Approach & Results In this retrospective investigation, we included 123 COVID-19 patients admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from January 5 to March 7, 2020. All enrolled patients are the laboratory confirmed COVID-19 pneumonia cases according to the criteria reported previously. A total of 123 patients were analyzed for their Clinical records, laboratory results including the diagnosis of HBV infection and liver function. Among 123 confirmed COVID-19 patients, the mean age was 51 years old and 59.3% were females (73/123). Fifteen were previously HBV infected patients, 66.7% of them were males (10/15), patients with HBV infection appeared to have a higher incidence of liver cirrhosis and an increased level of total bilirubin. Seven (46.7%) patients with HBV infection were defined as severe cases, while the severity rate was 24.1% for the patients without HBV infection (26/108). The mortality of patients with HBV infection was 13.3% (2/15) compared to 2.8% (3/108) for the patients without HBV infection. Conclusions SARS-CoV-2 infection may cause liver function damage in COVID-19 cases and the patients with HBV infection are likely to have more severe disease outcome. Severe patients were defined according to the Guideline of the treatment of COVID- The treatment was mainly the supportive care (Table 1) . Seventy-four patients were 1 7 9 given antiviral (arbidol, orally, 200 mg, three times per day), and 74 with oxygen 1 8 0 support. Antibiotic therapy, both orally and intravenous, were given as described in 1 8 1 and creatinine. All of these biochemical features were found normal; however, the 1 9 1 level of total bilirubin was higher in patients with HBV infection (p=0.0178, Table 2 ). The blood counts of the patients with or without HBV infection showed lymphopenia 1 9 3 (< 1.3 ×10 9 /L). 1 9 4 1 9 5 Hepatitis B serological markers of COVID-19 patients with HBV infection 1 9 6 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 27, 2020 . . https://doi.org/10.1101 /2020 Fifteen COVID-19 patients were examined to be HBsAg positive (5 females and 10 1 9 7 males). The data of anti-HBsAg, HBeAg, anti-HBeAg and anti-HBcAg were 1 9 8 available for 11 patients with ten patients HBeAg negtive and one positive. The value 1 9 9 of HBV-DNA was collected from 13 patients. The HBV-DNA level of 10 patients are 2 0 0 more than 20 IU/ml (Table S1 ). showed higher mortality rate compared to those COVID-19 patients without HBV 2 1 0 infection (13.3%vs 2.8%, Table 2 ). cause patients severe respiratory symptoms and even leads to death with average 2 1 5 mortality rate of 3.4% (according to the data reported from WHO) though most cases 2 1 6 of COVID-19 are acute and resolve fast. Liver damage has been identified in around 2 1 7 60% of patients suffering from SARS and viral RNA was detected by RT-PCR in 2 1 8 liver tissue(10), which providing the evidence that SARS-CoV involved in live injure. Liver impairment has been also reported in MERS patients(11). According to the 2 2 0 clinical reports from different centers with large scale of COVID-19 cases, SARS- CoV-2 has been found to be associated with damage or dysfunction of liver tissue(9, 2 2 2 12-18) and about 14% -53% COVID-19 cases showed liver function damage with 2 2 3 abnormal level of alanine aminotransferase (ALT) and aspartate aminotransferase 2 2 4 (AST). Our study is in line with previous observations. We found in COVID-19 cases 2 2 5 without HBV infection that about 50.9% (55/108) patients have the dysfunction of 2 2 6 liver symptoms by measuring the level of ALT, AST, total bilirubin (TBIL), gamma-2 2 7 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 27, 2020. . https://doi.org/10.1101/2020.03.23.20040733 doi: medRxiv preprint glutamyltransferase (GGT), and alkaline phosphatase (ALP) during the disease 2 2 8 progress. In our enrolled cases, we also discovered that there is higher incidence of 2 2 9 abnormal liver function (81.8%, 27/33) in severe COVID-19 patients than did in mild 2 3 0 cases(43.3%, 39/90, data not shown), which agrees with the study that lower 2 3 1 incidence of AST abnormality was found in the cases diagnosed by CT scan on the 2 3 2 subclinical stage than in the COVID-19 patients who were confirmed after onset of 2 3 3 symptom(15). Therefore, liver function could be considered as one factor to indicate 2 3 4 the progress of COVID-19. According to other study from 1099 cases, around 23.7% of confirmed COVID-19 2 3 6 patients have at least one comorbidity(13). Among these pre-existing chronic diseases, 2 3 7 abnormal liver function is one of most common features in COVID-19 patients and 2 3 8 severe patients are more likely to have HBV infection. In our research, about one out 2 3 9 of five (21.8%) COVID-19 severe patients were found to coinfect with HBV infection. It has been suggested that liver impairment in COVID-19 patients could be due to the pointed out that as high as around 50% of HBV patients were identified as severe 2 4 5 COVID-19 cases. It is more likely that HBV patients will suffer from more severe 2 4 6 situation during the disease progress when were encountered with SARS-CoV-2 2 4 7 infection. In our enrolled cases, two patients with SARS-CoV and HBV coinfection 2 4 8 died on admission. One patient died from severe liver disease, haptic sclerosis. And 2 4 9 the other died from intestinal hemorrhage, which seems to be associated the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 27, 2020. . https://doi.org/10. 1101 /2020 In conclusion, by respectively analyzing the patients with coinfection of SARS-CoV-2 6 0 2 and HBV, we found that the patients with pre-existing HBV infection will be much 2 6 1 more vulnerable to SARS-CoV-2 infection. During the pandemic of SARS-CoV-2 2 6 2 infection, HBV patients should be given the specific protection. . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 27, 2020. . , Y a o H , T s a n g T Y , C h o w T C , Y e u n g Y C , C h o i K W , e t a l . 2 9 8 S A R S -a s s o c i a t e d v i r a l h e p a t i t i s c a u s e d b y a n o v e l c o r o n a v i r u s : r e p o r t o f t h r e e c a s e s . 2 9 9 H e p a t o l o g y 2 0 0 4 ; 3 9 : 3 0 2 -3 1 0 . 3 0 0 1 1 . A l s a a d K O , H a j e e r A H , A l B a l w i M , A l M o a i q e l M , A l O u d a h N , A l A j l a n A , 3 0 1 A l J o h a n i S , e t a l . H i s t o p a t h o l o g y o f M i d d l e E a s t r e s p i r a t o r y s y n d r o m e c o r o n o v i r u s 3 0 2 ( . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 27, 2020. Total bilirubin Alkaline phosphatase (U/L)