COVID-19 in patients with hepatobiliary and pancreatic diseases: A single-centre cross-sectional study in East London
Abu Z M Dayem Ullah, PhD student Lavanya Sivapalan, Hemant M Kocher, Claude Chelala
doi:10.1101/2020.09.07.20189621
Objective To explore risk factors associated with COVID-19 susceptibility and survival in patients with pre-existing hepato-pancreato-biliary (HPB) conditions. Design Cross-sectional study. Setting East London Pancreatic Cancer Epidemiology (EL-PaC-Epidem) study at Barts Health NHS Trust, UK. Linked electronic health records were interrogated on a cohort of participants (age ≥ 18 years), reported with HPB conditions between 1 April 2008 and 6 March 2020. Participants EL-PaC-Epidem study participants, alive on 12 February 2020, and living in East London within the previous six months (n=15 440). The cohort represents a multi-ethnic population with 51.7% belonging to the non-White background. Main outcome measure COVID-19 incidence and mortality. Results Some 226 (1.5%) participants had confirmed COVID-19 diagnosis between 12 February and 12 June 2020, with an increased odds for men (OR 1.56; 95% CI 1.2 to 2.04) and Black ethnicity (2.04; 1.39 to 2.95) as well as patients with moderate to severe liver disease (2.2; 1.35 to 3.59). Each additional comorbidity increased the odds of infection by 62%. Substance mis-users were at more risk of infection, so were patients on Vitamin D treatment. The higher odds ratios in patients with chronic pancreatic or mild liver conditions, age>70, and history of smoking or obesity were due to co-existing comorbidities. Increased odds of death were observed for men (3.54; 1.68 to 7.85) and Black ethnicity (3.77; 1.38 to 10.7). Patients having respiratory complications from COVID-19 without a history of chronic respiratory disease also had higher odds of death (5.77; 1.75 to 19).
Conclusions In this large population-based study of HPB patients, men, Black ethnicity, pre-existing moderate to severe liver conditions, six common medical multimorbidities, substance mis-use, and a history of Vitamin D treatment independently posed higher odds of acquiring COVID-19 compared to their respective counterparts. The odds of death were significantly high for men and Black people.
FOOTNOTES Contributors: ADU designed the study, and was responsible for undertaking and completing data collection, processing and analysis. HMK and CC oversaw the conduct and management of the study. All the authors contributed to the selection of study variables and interpretation post analysis. ADU wrote the first drafts of the report and all the authors made critical revisions. Data sharing: All statistical data relevant to the study are included in the article or uploaded as supplementary information. Only the corresponding author had full access to all the participants' data in the study. The authors confirm that researchers seeking the completely anonymised final analysis dataset for this work can submit a data request to the corresponding author. Transparency statement: The corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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