COVID-19 in Patients with Hepatobiliary and Pancreatic Diseases in East London: A Single-Centre Cohort Study

Abstract

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing COVID-19 in patients with pre-existing hepatobiliary and pancreatic (HPB) conditions is not clearly understood. Methods: In a single-centre retrospective cohort study (Barts Health NHS Trust, East London), linked primary, secondary and tertiary care electronic health records for patients diagnosed newly or with pre-existing HPB diseases since 2008 till March 6, 2020 were interrogated to identify COVID-19 cases between February 12 and June 12, 2020. We conducted risk analyses to identify the effect of demographics, comorbidities and associated medication use, and lifestyle factors and with appropriate adjustment for gender, ethnicity, age group and HPB diagnoses on COVID-19 incidence and mortality. Findings: Some 212 (1·4%) of 15586 patients with existing HPB conditions had confirmed diagnosis of COVID-19, with an increased risk for men (Relative Risk (RR)=1.59 [95% CI 1·21–2·09]) and Black ethnicity (RR= 2·2 [1·5–3·18]) amongst demographic features. The increased risk for South Asian ethnicity, patients with pre-existing non-malignant pancreatic or liver conditions, and age>70 years seemed to be due to underlying comorbidities in these particular groups. Each additional comorbidity increased the risk of infection by 60%. Both current and past substance mis-users were at more risk of COVID-19 (RR= 2·5 [1·58–4·05] and 3.65 [1·81–7], respectively). The high risk associated with past smokers was largely associated with co-existing respiratory or cardiovascular diseases; surprisingly current smokers were associated with a lower risk of infection (RR=0·58 [0·35–0·93]). HPB patients on current or past Vitamin D treatment were at increased risk of COVID-19 (RR= 2·26 [1·6–3·12] and 2·55[1·55–3·95], respectively). Black ethnicity was at increased mortality risk (RR=2.4 [1·35–3·48]). COVID-19 patients with a pre-existing kidney condition had a higher risk of death (RR=2·13 [1·16–3·55]), particularly when accompanied with an acute episode of renal complications (RR=2·74 [1·32–5·13]). Interpretation: In a large multi-ethnic population-based study of HPB patients, male gender, Black ethnicity, medical co-morbidities, and substance mis-use independently posed a higher risk of acquiring COVID-19. Particular attention should be paid to patients with a pre-existing kidney disease to further renal insult to prevent fatality. Funding: The study is conducted under an umbrella study, focusing on the epidemiology of pancreatic and other hepatobiliary cancers in East London, funded by Medical Research Council UK as a UKRI/Rutherford Fellowship to ADU. No additional funding has been received for this study.Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: The EL-PaC-Epidem study was approved by the East of England - Essex Research Ethics Committee (19/EE/0163; May 17, 2019) and supported by the NHS Confidentiality Advisory Group for collecting and processing confidential patient information without consent (19/CAG/0219; January 17, 2020).