COVID-19 Among Patients With Hepatitis B or Hepatitis C: A Systematic Review

  1. Hossein Mirzaie
  2. Mohammad Vahidi
  3. Mostafa Shokoohi
  4. Maryam Darvishian
  5. Hamid Sharifi
  6. Heidar Sharafi
  7. Mohammad Karamouzian

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Abstract

Context: Hepatic manifestations of Coronavirus Disease 2019 (COVID-19) are common among people living with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Objectives: This systematic review aimed to summarize the evidence on COVID-19 patients living with HBV or HCV co-infections. Data Sources: We searched multiple electronic databases and preprint servers from December 1, 2019, to August 9, 2020. Study Selection: Studies were included if they reported quantitative empirical data on COVID-19 patients living with HBV or HCV co-infections. Data Extraction: Descriptive analyses were reported, and data were synthesized narratively. The quality assessment was completed using the Joanna Briggs Institute critical appraisal tools. Results: Out of the 941 uniquely identified records, 27 studies were included. Of the eligible studies, 232 COVID-19 patients were living with HBV and 22 were living with HCV. Most patients were male, and the mean age was 49.8 and 62.8 years in patients living with HBV and HCV, respectively. Among the reported cases of SARS-CoV-2-HBV co-infection, the proportions of death were 4.7% and 15% in cross-sectional and case series/report studies, respectively. The death proportion was 8.3% among the reported cases of SARS-CoV-2-HCV co-infection. Among COVID-19 patients, 34.1% and 76.2% reported at least one comorbidity besides HBV and HCV infections, mainly hypertension and type 2 diabetes mellitus. The most common COVID-19-related symptoms in both HBV and HCV groups were fever, cough, dyspnea, fatigue, and gastrointestinal symptoms. Conclusions: While understanding the pathogenesis of SARS-CoV-2 requires further investigations, the careful assessment of hepatic manifestations and chronic infections, such as HBV and HCV upon the admission of COVID-19 patients could help reduce multimorbidity among HBV or HCV patients and lead to more favorable health outcomes among them.

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  1. Version published to 10.5812/hepatmon.111617
  2. ScreenIT

    SciScore for 10.1101/2020.10.22.20216317: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Literature search: Following the Systematic Reviews and Meta-Analyses (PRISMA) and Peer Review of Electronic Search Strategies (25) guidelines (see supplementary file S1 for PRISMA checklist), we searched PubMed, Scopus, Web of Science, CINAHL, Embase, Google Scholar, as well as preprint databases including medRxiv and bioRxiv from December 1, 2019 to August 9, 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    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:
    We acknowledge the limitations of our study. First, while most COVID-19 patients are asymptomatic, the available evidence which informed this review included mostly hospitalized patients and is skewed towards more severe patients often with a history of organ transplant and advanced liver disease; therefore, our findings are not generalizable to all patients living with COVID-19 and HBV or HCV co-morbidities. Second due to descriptive design of included studies and lack of comparison group we could not identify factors associated with SARS-CoV-2-HBV or HCV co-infections. Third, most of the included studies had a small sample size and without a population-based survey of patients with HBV or HCV, the accurate prevalence of COVID-19 and its manifestations among HBV or HCV subpopulations remain unknown. Lastly, given the growing nature of the pandemic and the overwhelmed healthcare systems worldwide, viral hepatitis manifestations may be under-recorded or overlooked during clinical visits and therefore, underestimate the scope of hepatic manifestations among COVID-19 with HBV and HCV co-infections. Conclusion: Our findings suggest that COVID-19 patients with HBV and HCV co-infections may be at an increased risk of morbidity and mortality. Despite the limitations of the existing evidence, our review suggests that liver enzyme abnormalities and acute hepatic injuries may be common among COVID-19 patients with HBV and HCV co-infections. Therefore, these paraclinical profiles should...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.10.22.20216317v1 on medRxiv