Survival and outcomes for co-infection of chronic hepatitis C with and without cirrhosis and COVID-19: A multicenter retrospective study

Table 1 Baseline demographic features of patients (n = 125 patients)

Item	n (%)
Egyptian governorate
Cairo	78 (62.4)
Al-Menofeya	17 (13.6)
Giza	14 (11.2)
Al-Qalubya	9 (7.2)
Al-Behera	7 (5.6)
Age (yr)
20 to 30	1 (0.8)
30 to 40	6 (4.8)
40 to 50	10 (8.1)
50 to 60	31 (25.0)
60 to 70	35 (28.2)
70 to 80	35 (28.2)
80 to 90	6 (4.8)
Gender
Male	86 (68.8)
Female	39 (31.2)
Cigarette smoking	10 (8.0)
History of contact with COVID-19 case	32 (25.6)
Diabetes mellitus	52 (41.6)
Hypertension	52 (41.6)
Direct-acting antiviral therapy treatment
Not previously treated	108 (86.4)
Sustained virological response	17 (13.6)
COPD	1 (0.8)
Coronary artery disease	12 (9.6)
Acute kidney injury	1 (0.8)
Chronic renal insufficiency	8 (6.4)
Heart failure	2 (1.6)
Bronchial asthma	1 (0.8)
CT pattern	1 (0.8)
Consolidations and ground-glass opacities	31 (24.8)
Ground-glass opacities	94 (75.2)
Lesion distribution on CT
Bilateral	122 (97.6)
Unilateral	3 (2.4)
COVID-19 case severity
Moderate	86 (68.8)
Severe	39 (31.2)
Admission zone
ICU	24 (19.2)
Intermediate care	6 (4.8)
Ward	95 (76.0)

COVID-19: Coronavirus disease 2019; COPD: Chronic obstructive pulmonary disease;

CT: Computed tomography; ICU: Intensive care unit.

Table 2 Symptoms of the studied patients

Symptom	n (%)
Dyspnea	80 (64.0)
Fever	78 (62.4)
Cough	55 (44.0)
Fatigue	26 (20.8)
Disturbed consciousness	22 (17.6)
Sore throat	15 (12.0)
Newly developed hepatic encephalopathy	15 (12.0)
Hepatocellular carcinoma	15 (12.0)
Myalgia	12 (9.6)
Current ascites	9 (7.2)
History of hematemesis from esophageal varices	9 (7.2)
Asymptomatic	5 (4.0)
Diarrhea	5 (4.0)
Arthralgia	5 (4.0)
Anorexia	4 (3.2)
Nausea	3 (2.4)
Vomiting	3 (2.4)
Loss of taste	2 (1.6)
Hemoptysis	1 (0.8)
Abdominal pain	1 (0.8)
Loss of smell	1 (0.8)
Jaundice	1 (0.8)
Rhinorrhea	1 (0.8)

Table 3 Baseline laboratory results and treatments of the studied 125 patients

	mean ± SD/n (%)
Pulse rate	92 ± 17
Temperature	37 ± 1
Respiratory rate	23 ± 5
Oxygen saturation	93 ± 5
Hemoglobin (gm/dL)	12 ± 2
Platelet count (× 1000/cmm)	183 ± 107
Total leucocyte count (× 1000/cmm)	10 ± 8
Neutrophil : Lymphocyte ratio	1 ± 0
INR	1.16 ± 0.29
PTT	33.9 ± 13.2
Serum creatinine (mg/dL)	1.39 ± 1.43
Serum sodium (mEq/L)	137 ± 9
Serum potassium (mEq/L)	4.18 ± 0.77
Total bilirubin (mg/dL)	3 ± 5
Direct bilirubin (mg/dL)	2.1 ± 3.8
Serum albumin (g/dL)	3.2 ± 0.7
Alanine Transaminase (U/L)	58 ± 53
Aspartate Transaminase (U/L)	92 ± 123
Alkaline phosphatase (U/L)	262 ± 226
Serum ferritin (ng/mL)	667 ± 483
D-dimer (mg/mL)	1560 ± 2503
Fibrinogen (mg/dL) × 100 if presented in g/L	77
Azithromycin	72 (57.6)
Paracetamol	45 (36.0)
Supplementary vitamin C	85 (68.0)
Zinc	69 (55.2)
Colchicine	2 (1.6)
Lactoferrin	18 (14.4)
Other antibiotics	71 (56.8)
Steroids	38 (30.4)
Hydroxyl-chloroquine	29 (23.2)
Low-molecular weight heparin	56 (44.8)
Warfarin	3 (2.4)

PTT: Partial thromboplastin time; INR: International normalized ratio.

Table 4 Baseline features and symptoms of patients with and without liver cirrhosis

Variable		No liver cirrhosis61 (48.8%)	Liver cirrhosis 64 (51.2%)	P value
Gender	Male	42 (68.9%)	44 (68.8%)	0.57
	Female	19 (31.1%)	20 (31.3%)
Age (yr)	20 to 30	0 (0.0%)	1 (1.6%)	0.004
	30 to 40	3 (4.9%)	3 (4.8%)
	40 to 50	0 (0.0%)	10 (15.9%)
	50 to 60	19 (31.1%)	12 (19.0%)
	60 to 70	14 (23.0%)	21 (33.3%)
	70 to 80	21 (34.4%)	14 (22.2%)
	80 to 90	4 (6.6%)	2 (3.2%)
Cigarette smoking		2 (3.2%)	8 (11.5%)	0.06
Diabetes mellitus		24 (39.3%)	28 (43.8%)	0.71
Hypertension		23 (37.7%)	29 (45.3%)	0.46
COPD		0 (0.0%)	1 (1.6%)	1
Coronary artery disease		5 (8.2%)	7(10.9%)	0.76
Chronic renal insufficiency		4 (6.6%)	4 (6.3%)	1
Heart failure		0	2 (3.1%)	0.49
Hepatocellular carcinoma		3 (4.9%)	12 (18.8%)	0.026
Esophageal varices		0 (0.0%)	9 (14.1%)	0.003
Asymptomatic		1 (1.6%)	4 (6.3%)	0.36
Fever		35 (57.4%)	43 (67.2%)	0.27
Cough		18 (29.5%	37 (57.8%)	0.002
Dyspnea		44 (72.1%)	36 (56.3%)	0.09
Sore throat		2 (3.3%)	13 (20.3%)	0.005
Hemoptysis		0 (0.0%)	1 (1.6%)	1
Fatigue		5 (8.2%)	21 (32.8%)	0.001
Anorexia		1 (1.6%)	3 (4.7%)	0.62
Diarrhea		0 (0.0%)	5 (7.8%)	0.05
Nausea		1 (1.6%)	2 (3.1%)	1
Vomiting		1 (1.6%)	2 (3.1%)	1
Abdominal pain		1 (1.6%)	0 (0.0%)	0.48
Arthralgia		1 (1.6%)	4 (6.3%)	0.36
Myalgia		1 (1.6%)	11 (17.2%)	0.004
Loss of taste		0 (0.0%)	2 (3.1%)	0.49
Loss of smell		0 (0.0%)	1 (1.6%)	1
Disturbed consciousness		3 (4.9%)	19 (29.7%)	0.001
Hepatic encephalopathy		0 (0.0%)	15 (23.4%)	0.033
Direct-acting antiviral therapy with sustained virological response before COVID-19 infection		7 (11.5%)	10 (15.6%)	0.61

COPD: Chronic obstructive pulmonary disease; COVID-19: Coronavirus disease 2019.

Table 5 Comparison between patients with and without liver cirrhosis

			No liver cirrhosis 61 (48.8%)	Liver cirrhosis 64 (51.2%)	P value
Hemoglobin (mg/dL)			12 ± 2	12 ± 2	0.85
Platelet count (× 1000/cmm)			193 ± 107	171 ± 107	0.36
TLC (× 1000/cmm)			12 ± 10	9 ± 5	0.31
Serum creatinine (mg/dL)			1.58 ± 1.89	1.21 ± 0.76	0.59
Total bilirubin (mg/dL)			3 ± 4	3 ± 5	0.79
Serum albumin (g/dL)			3.3 ± 0.7	3.1 ± 0.6	0.36
Alanine transaminase (U/L)			67 ± 67	50 ± 40	0.21
Aspartate transaminase (U/L)			60 ± 37	101 ± 137	0.89
CT pattern	Consolidations and ground-glass opacities		4 (6.55%)	28 (43.75%)	< 0.001
	Ground-glass opacities		57 (93.45%)	36 (56.25%)
Lesion distribution on CT	Bilateral		58 (95.1%)	64 (100.0%)	0.11
	Unilateral		3 (4.9%)	0
COVID-19 severity	Moderate		50 (81.96%)	35 (54.69%)	0.003
	Severe		11 (18.04%)	29 (45.31%)
Azithromycin			33 (54.1%)	39 (60.9%)	0.47
Paracetamol			16 (26.2%)	29 (45.3%)	0.04
Supplementary vitamin C			37 (60.7%)	48 (75.0%)	0.12
Supplementary zinc			33 (54.1%)	36 (56.3%)	0.85
Lactoferrin			3 (4.9%)	15 (23.4%)	0.004
Other antibiotics			28 (45.9%)	43 (67.2%)	0.019
Anticoagulants		LMWH	28 (45.9%)	28 (43.8%)	1
		Warfarin	1 (1.6%)	2 (3.1%)	1
Steroids			16 (26.2%)	22 (34.4%)	0.339
Alive (discharged)			52 (85.25%)	31 (48.44%)	< 0.001
Died at the hospital			9 (14.75%)	33 (51.56%)

TLC: Thin layer chromatography; CT: Computed tomography; COVID-19: Coronavirus disease 2019.

Table 6 Multivariate regression analysis of factors affecting mortality

	B	S.E.	P value	Odds ratio	95%CI
					Lower	Upper
Male	1.969	0.606	0.001	7.166	2.185	23.506
Diabetes mellitus	1.393	0.508	0.006	4.029	1.488	10.906
Liver cirrhosis	2.274	0.515	0.0001	1.103	1.037	1.282
Constant	-1.879	0.604	0.002	0.153

Table 7 Comparison between patients with COVID-19 who received or did not receive previous direct-acting antiviral therapy

		Did not receive previous DAA (n = 108)	Received previous DAA (n = 17)	P value
COVID-19 severity	Moderate	72 (66.7%)	14 (82.4%)	0.26
	Severe	36 (33.3%)	3 (17.6%)
Admission zone	ICU	22 (20.4%)	2 (11.8%)	0.52
	Intermediate care	6 (5.6%)	0 (0.0%)
	Ward	80 (74.1%)	15 (88.2%)
Vital status	Alive	73 (67.6%)	12 (70.6%)	1
	Dead	35 (32.4%)	5 (29.4%)
Total bilirubin (mg/dL)		1.00 (1-20)	1.30 (1-6)	0.84
Direct bilirubin (mg/dL)		0.9 (0.2-15.6)	0.9 (0.1-2.7)	0.93
Serum albumin (g/dL)		3.1 (1.7-5)	3.15 (2.4-3.8)	0.45
Alanine transaminase (U/L)		41.5 (13-324)	49 (18-175)	0.54
Aspartate transaminase (U/L)		46.5 (10- 549)	53 (16-415)	0.42

DAA: Direct-acting antiviral; COVID-19: coronavirus disease 2019; ICU: Intensive care unit.