Patients with COVID-19 and HBV Coinfection are at Risk of Poor Prognosis

Objective: Aim to study: 1. Whether there is a difference in the risk of death / critical illness between different stages of HBV (Resolved hepatitis B, HBeAg (-) CHB/infection, HBeAg (+) CHB/infection and HBV reactivation) coinfected with COVID-19; 2.If there is a difference, whether it is due to abnormal liver function and how much.Methods: This cohort study included all covid-19 inpatients of a single-center tertiary care academic hospital in Wuhan, Hubei, China, between February 4, 2020 and followed up to April 14, 2020. A total of 2899 COVID-19 patients were included as participants in this study and they were divided into five groups based on infection status of hepatitis B. Follow-up for mortality and ICU was carried out during hospitalization.Results: The median follow-up time was 39 (IQR,30-50) days with 66 deaths and 126 ICU. after adjustment, compared to patients without CHB, the hazard ratio (HR) for ICU was 8.02 (95% CI: 4.77-13.49) for patients with HBeAg (+) CHB/infection, and 5.15 (95% CI: 1.66-16.02) for those with HBV reactivation. And HR for death was 11.57 (95% CI: 6.30-21.26) for patients with HBeAg (+) CHB/infection. The results of mediating effect indicated the total effect of HBeAg (+) CHB/infection on death/ICU is partially mediated by abnormal liver function, accounted for 79.60% and 73.53%, respectively.Conclusion: COVID-19 patients coinfected with HBV at HBeAg (+) CHB/infection stage will increase the risk of poor prognosis, and abnormal liver function partially mediates the increased risk effect of poor prognosis caused by the coinfection.Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Medical Ethics Committee of the Chinese PLA General Hospital.