Chronic hepatitis-C infection in COVID-19 patients is associated with in-hospital mortality

BACKGROUND There is little evidence about the association of pre-existing hepatitis C infection(HCV)with outcomes in patients with coronavirus disease 2019(COVID-19).AIM To assess the prevalence of history of HCV among patients with COVID-19 and to study the relationship of in-hospital mortality in relation with other predictors of poor outcomes in the presence or absence of COVID-19 induced acute liver injury.METHODS In a retrospective single-center study design,1193 patients with COVID-19 infection were studied.Patients were then classified into those with and without a history of HCV,50(4.1%)and 1157(95.9%)respectively.RESULTS Multivariate cox-regression models showed that age,HCV,D-Dimer,and ferritin were the only predictors of in-hospital mortality.Acute liver injury and fibrosis score(Fib-4 score)were not different between both groups.Multivariate coxregression model for liver profile revealed that aspartate aminotransferase/alanine aminotransferase ratio,Fib-4 score,and HCV were predictors of inhospital mortality.After propensity score matching HCV was the only predictor of mortality in the multivariate cox-regression model.A model including HCV was found to add predictive value to clinical and laboratory parameters.CONCLUSION In patients with COVID-19,history of HCV infection leads to an accentuated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virulence,irrespective of baseline comorbidities,admission laboratory variables,or COVID-19-induced liver injury,which may be related to extrahepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 viral entry,baseline cytokine-mediated pro-inflammation,and endothelial dysfunction.