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

Abstract

Background: 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. Methods: 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. Results: 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, p = 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 (p = 0.127). Conclusions: Concomitant HS was associated with increased risk of ALI among people with CHB infection suffering from SARS‐CoV‐2 infection.