COVID-19 in patients with hepatobiliary and pancreatic diseases: A single-centre cross-sectional study in East London

Abstract

Objective

To explore risk factors associated with COVID-19 susceptibility and survival in patients with pre-existing hepato-pancreato-biliary (HPB) conditions.

Design

Cross-sectional study.

Setting

East London Pancreatic Cancer Epidemiology (EL-PaC-Epidem) study at Barts Health NHS Trust, UK. Linked electronic health records were interrogated on a cohort of participants (age ≥ 18 years), reported with HPB conditions between 1 April 2008 and 6 March 2020.

Participants

EL-PaC-Epidem study participants, alive on 12 February 2020, and living in East London within the previous six months (n=15 440). The cohort represents a multi-ethnic population with 51.7% belonging to the non-White background.

Main outcome measure

COVID-19 incidence and mortality.

Results

Some 226 (1.5%) participants had confirmed COVID-19 diagnosis between 12 February and 12 June 2020, with an increased odds for men (OR 1.56; 95% CI 1.2 to 2.04) and Black ethnicity (2.04; 1.39 to 2.95) as well as patients with moderate to severe liver disease (2.2; 1.35 to 3.59). Each additional comorbidity increased the odds of infection by 62%. Substance mis-users were at more risk of infection, so were patients on Vitamin D treatment. The higher odds ratios in patients with chronic pancreatic or mild liver conditions, age>70, and history of smoking or obesity were due to co-existing comorbidities. Increased odds of death were observed for men (3.54; 1.68 to 7.85) and Black ethnicity (3.77; 1.38 to 10.7). Patients having respiratory complications from COVID-19 without a history of chronic respiratory disease also had higher odds of death (5.77; 1.75 to 19).

Conclusions

In this large population-based study of HPB patients, men, Black ethnicity, pre-existing moderate to severe liver conditions, six common medical multi-morbidities, substance mis-use, and a history of Vitamin D treatment independently posed higher odds of acquiring COVID-19 compared to their respective counterparts. The odds of death were significantly high for men and Black people.

STRENGTHS AND LIMITATIONS OF THIS STUDY

First multi-ethnic population-based study on COVID-19 in patients with hepato-pancreato-biliary group of diseases.
Systematic identification of the effect, or the lack of it, of individual demographic and clinical factors on the infection and mortality of COVID-19 in a large cohort of over 15 000 patients, robustly controlling for potential confounders in their evaluation.
Access to longitudinal data from linked primary and secondary care electronic health records, and use of rule-based phenotyping algorithms allowed for improved completeness and accuracy of the explored variables.
Some observed increased odds of SARS-CoV-2 infection and related death could be plausibly explained by unmeasured confounding.
The effects reported in the study could be influenced by the relatively smaller size of COVID-19 cases within this cohort.

SciScore for 10.1101/2020.09.07.20189621: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	IRB: The EL-PaC-Epidem study was approved by the East of England - Essex Research Ethics Committee (19/EE/0163; May 17, 2019) and supported by the NHS Confidentiality Advisory Group for collecting and processing confidential patient information without consent (19/CAG/0219; January 17, 2020). Consent: The EL-PaC-Epidem study was approved by the East of England - Essex Research Ethics Committee (19/EE/0163; May 17, 2019) and supported by the NHS Confidentiality Advisory Group for collecting and processing confidential patient information without consent (19/CAG/0219; January 17, 2020).
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	not detected.

Table 2: Resources

No key resources detected.

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

Our study also has some important limitations. In our cohort definition, only patients visiting BHNT hospitals and who were given a confirmed COVID-19 diagnosis code or tested positive for SARS-CoV-2 RNA were considered as having COVID-19. This may have resulted in some patients being incorrectly identified as not having COVID-19, particularly if they had a positive swab test via NHS coronavirus test sites or using a home test kit. However, our cohort had specific medical conditions with a high prevalence of comorbidities listed under the NHS categorisation of higher risk populations.3 Any manifestation of COVID-19 related symptoms would have likely resulted in these patients receiving treatment at one of the BHNT hospitals, and hence we were fairly confident on identifying all clinically relevant SARS-CoV-2 infections in our cohort within the three East London boroughs. A related limitation is associated with the confirmation of East London residency for the study cohort. Patients’ addresses (current or historic) are not collected under the umbrella study, which considers patients with HPB conditions (with the exception of cancer) treated or managed at BHNT hospitals as East London residents during the time of their care. The Royal London Hospital hosts one of the largest HPB centres in England, and supports suspected or confirmed HPB cancer patients from nearby geographical areas. As the umbrella study cohort is historic, we acknowledged the probability of people moving awa...

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

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