Impact of hepatic steatosis on risk of acute liver injury in people with chronic hepatitis B and SARS‐CoV‐2 infection

Abstract

<h3>Background</h3><p>SARS-CoV-2 infection was known to be associated with higher risk of liver impairment in people with chronic hepatitis B infection (CHB). However, evidence regarding the impact of concomitant hepatic steatosis (HS) on the risk of liver disease among people with CHB and SARS-CoV-2 infection is lacking. We investigated the impact of concomitant HS on people with CHB suffering from SARS-CoV-2 infection.</p><h3>Methods</h3><p>This retrospective cohort study was performed using an electronic health database for people in Hong Kong with CHB and confirmed SARS-CoV-2 infection between 21 January 2020 and 31 January 2023. People with HS diagnosis (HS + CHB + COVID-19) were identified and matched 1:1 by propensity score with those without (CHB + COVID-19). Each person was followed up until death, outcome event, or 31st January 2023. Study outcome was incidence of acute liver injury (ALI) within first 28 days since COVID-19 diagnosis. Severity of ALI and comparison of ALI risk stratified by the presence of CHB infection and HS were also analysed. Incidence rate ratios (IRRs) were estimated by Poisson regression models.</p><h3>Results</h3><p>Of 52 259 COVID-19 patients with CHB infection in the cohort, 15 391 people with HS + CHB + COVID-19 and 15 391 people with CHB + COVID-19 were included after matching. HS + CHB + COVID-19 was associated with increased risk of ALI (IRR: 1.41, 95% CI:1.05–1.90, <em>p</em> = 0.023), compared to CHB + COVID-19. Over 99% ALI cases were mild to moderate severity, and there were no differences in the severity of ALI between HS + CHB + COVID-19 and CHB + COVID-19 (<em>p</em> = 0.127).</p><h3>Conclusions</h3><p>Concomitant HS was associated with increased risk of ALI among people with CHB infection suffering from SARS-CoV-2 infection.</p>