Characteristics of Liver Function in Patients With SARS-CoV-2 and Chronic HBV Coinfection

Clin Gastroenterol Hepatol. 2021 Mar;19(3):597-603. doi: 10.1016/j.cgh.2020.06.017. Epub 2020 Jun 15.


Background & aims: Coronavirus disease 2019 (COVID-19) is a major global health threat. We aimed to describe the characteristics of liver function in patients with SARS-CoV-2 and chronic hepatitis B virus (HBV) coinfection.

Methods: We enrolled all adult patients with SARS-CoV-2 and chronic HBV coinfection admitted to Tongji Hospital from February 1 to February 29, 2020. Data of demographic, clinical characteristics, laboratory tests, treatments, and clinical outcomes were collected. The characteristics of liver function and its association with the severity and prognosis of disease were described.

Results: Of the 105 patients with SARS-CoV-2 and chronic HBV coinfection, elevated levels of liver test were observed in several patients at admission, including elevated levels of alanine aminotransferase (22, 20.95%), aspartate aminotransferase (29, 27.62%), total bilirubin (7, 6.67%), gamma-glutamyl transferase (7, 6.67%), and alkaline phosphatase (1, 0.95%). The levels of the indicators mentioned above increased substantially during hospitalization (all P < .05). Fourteen (13.33%) patients developed liver injury. Most of them (10, 71.43%) recovered after 8 (range 6-21) days. Notably the other, 4 (28.57%) patients rapidly progressed to acute-on-chronic liver failure. The proportion of severe COVID-19 was higher in patients with liver injury (P = .042). Complications including acute-on-chronic liver failure, acute cardiac injury and shock happened more frequently in patients with liver injury (all P < .05). The mortality was higher in individuals with liver injury (28.57% vs 3.30%, P = .004).

Conclusion: Liver injury in patients with SARS-CoV-2 and chronic HBV coinfection was associated with severity and poor prognosis of disease. During the treatment of COVID-19 in chronic HBV-infected patients, liver function should be taken seriously and evaluated frequently.

Keywords: COVID-19; HBV; Liver Injury; SARS-CoV-2.

MeSH terms

  • Adult
  • Aged
  • Alanine Transaminase / blood
  • Aspartate Aminotransferases / blood
  • Bilirubin / blood
  • COVID-19 / blood
  • COVID-19 / complications*
  • COVID-19 / mortality
  • China
  • Coinfection / blood
  • Coinfection / complications*
  • Coinfection / mortality
  • Female
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / complications*
  • Hepatitis B, Chronic / mortality
  • Hospitalization
  • Humans
  • Liver / physiopathology*
  • Liver Function Tests
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Rate


  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin