Corticosteroid Treatment in Severe Patients With SARS-CoV-2 and Chronic HBV Co-infection: a Retrospective Multicenter Study

Background: The impact of corticosteroids on severe patients with coronavirus disease 2019 (COVID-19)/ chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate effect of corticosteroid on these subgroup patients. Methods: . In this retrospective multicenter study including 5447 confirmed COVID-19 patients from Jan 1, 2020 to Apr 18, 2020, severe patients with COVID-19/HBV co-infection were identified. To minimize the bias of confounding variables on effect of corticosteroid treatment, inverse probability of treatment weighting (IPTW) based on propensity score was employed. Results: . The prevalence of HBV co-infection in hospitalization COVID-19 patients was 4.1%. 105 severe patients with COVID-19/HBV co-infection were enrolled (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. Corticosteroid treatment was associated with high D-dimer level, neutrophil count (all P <0.05). With IPTW analysis, corticosteroid treatment worsen acute liver injury (OR, 1.767, 95%CI, 1.018-3.065, P =0.043). Corticosteroids might delay SARS-CoV-2 viral RNA clearance (OR, 4.963, 95%CI, 2.717-9.065, P <0.001). The 28-day and in-hospital mortality were both significantly higher in corticosteroid treatment group than non-corticosteroid treatment group (OR, 8.738, 95%CI, 2.826-27.022, P <0.001; OR, 10.122, 95%CI, 3.291-31.129, P 1µg/ml) (OR, 10.686, 95%CI, 2.421-47.159, P =0.002) and corticosteroid therapy (OR, 11.236, 95%CI, 1.273-99.154, P =0.029) were independently associated with 28-day mortality. Methylprednisolone dose per day and cumulative dose in non-survivors was significantly higher than in survivors. Conclusions: . In severe patients with COVID-19/HBV co-infection, corticosteroid treatment may increase mortality. Therefore, corticosteroid therapy should be prescribed with caution in the subset of patients.