tetano
Editor, Senior Moderator
Hepatology
. 2021 Mar 13.
doi: 10.1002/hep.31797. Online ahead of print.
Outcome of COVID-19 in Patients with Autoimmune Hepatitis: an International Multi-Centre Study
Cumali Efe[SUP] 1 [/SUP], Renumathy Dhanasekaran[SUP] 2 [/SUP], Craig Lammert[SUP] 3 [/SUP], Berat Ebi[SUP] 4 [/SUP], Fatima Higuera-de la Tijera[SUP] 5 [/SUP], Costica Aloman[SUP] 6 [/SUP], Ali R?za Cal??kan[SUP] 7 [/SUP], Mirta Peralta[SUP] 8 9 [/SUP], Alessio Gerussi[SUP] 10 11 [/SUP], Hatef Massoumi[SUP] 12 [/SUP], Andreea M Catana[SUP] 13 [/SUP], Murat Torgutalp[SUP] 14 [/SUP], Tugrul Purnak[SUP] 15 [/SUP], Cristina Rigamonti[SUP] 16 [/SUP], Andres Jose Gomez Aldana[SUP] 17 [/SUP], Nidah Khakoo[SUP] 18 [/SUP], H?seyin Kacmaz[SUP] 7 [/SUP], Leyla Nazal[SUP] 19 [/SUP], Shalom Frager[SUP] 12 [/SUP], Nurhan Demir[SUP] 20 [/SUP], Kader Irak[SUP] 21 [/SUP], Zeynep Meleko?lu Ellik[SUP] 22 [/SUP], Yasemin Balaban[SUP] 23 [/SUP], Kadri Atay[SUP] 24 [/SUP], Fatih Eren[SUP] 25 [/SUP], Laura Cristoferi[SUP] 10 11 [/SUP], Ersin Bat?bay[SUP] 1 [/SUP], ?lvaro Urzua[SUP] 26 [/SUP], Romee Snijders[SUP] 27 [/SUP], Murat K?y?c?[SUP] 28 [/SUP], Murat Aky?ld?z[SUP] 29 [/SUP], Naz?m Ekin[SUP] 4 [/SUP], Rotonya M Carr[SUP] 30 [/SUP], Murat Harputo?lu[SUP] 31 [/SUP], Ibrahim Hatemi[SUP] 32 [/SUP], Manuel Mendizabal[SUP] 9 33 [/SUP], Marcelo Silva[SUP] 9 33 [/SUP], Ramazan Idilman[SUP] 22 [/SUP], Marina Silveira[SUP] 34 [/SUP], Joost P H Drenth[SUP] 27 [/SUP], David N Assis[SUP] 34 [/SUP], Einar Bj?rnsson[SUP] 35 36 [/SUP], James L Boyer[SUP] 34 [/SUP], Pietro Invernizzi[SUP] 10 11 [/SUP], Chyntia Levy[SUP] 18 [/SUP], Thomas D Schiano[SUP] 37 [/SUP], Ezequiel Ridruejo[SUP] 9 33 38 [/SUP], Staffan Wahlin[SUP] 39 [/SUP]
Affiliations
Abstract
Background: Data regarding outcome of Coronavirus disease 2019 (COVID-19) in patients with autoimmune hepatitis (AIH) are lacking.
Patients and methods: We performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated.
Results: We included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe COVID-19 (15.5% vs 20.2% p=0.231) and all-cause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p<0.001; OR 17.46[4.22-72.13]). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19.
Conclusions: This international, multi-center study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in AIH patients. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19, but did lower the risk for new-onset liver injury during COVID-19.
Keywords: Liver transplantation; autoimmunity; immunosuppression; liver failure; mycophenolate mofetil; steroids; tacrolimus.
. 2021 Mar 13.
doi: 10.1002/hep.31797. Online ahead of print.
Outcome of COVID-19 in Patients with Autoimmune Hepatitis: an International Multi-Centre Study
Cumali Efe[SUP] 1 [/SUP], Renumathy Dhanasekaran[SUP] 2 [/SUP], Craig Lammert[SUP] 3 [/SUP], Berat Ebi[SUP] 4 [/SUP], Fatima Higuera-de la Tijera[SUP] 5 [/SUP], Costica Aloman[SUP] 6 [/SUP], Ali R?za Cal??kan[SUP] 7 [/SUP], Mirta Peralta[SUP] 8 9 [/SUP], Alessio Gerussi[SUP] 10 11 [/SUP], Hatef Massoumi[SUP] 12 [/SUP], Andreea M Catana[SUP] 13 [/SUP], Murat Torgutalp[SUP] 14 [/SUP], Tugrul Purnak[SUP] 15 [/SUP], Cristina Rigamonti[SUP] 16 [/SUP], Andres Jose Gomez Aldana[SUP] 17 [/SUP], Nidah Khakoo[SUP] 18 [/SUP], H?seyin Kacmaz[SUP] 7 [/SUP], Leyla Nazal[SUP] 19 [/SUP], Shalom Frager[SUP] 12 [/SUP], Nurhan Demir[SUP] 20 [/SUP], Kader Irak[SUP] 21 [/SUP], Zeynep Meleko?lu Ellik[SUP] 22 [/SUP], Yasemin Balaban[SUP] 23 [/SUP], Kadri Atay[SUP] 24 [/SUP], Fatih Eren[SUP] 25 [/SUP], Laura Cristoferi[SUP] 10 11 [/SUP], Ersin Bat?bay[SUP] 1 [/SUP], ?lvaro Urzua[SUP] 26 [/SUP], Romee Snijders[SUP] 27 [/SUP], Murat K?y?c?[SUP] 28 [/SUP], Murat Aky?ld?z[SUP] 29 [/SUP], Naz?m Ekin[SUP] 4 [/SUP], Rotonya M Carr[SUP] 30 [/SUP], Murat Harputo?lu[SUP] 31 [/SUP], Ibrahim Hatemi[SUP] 32 [/SUP], Manuel Mendizabal[SUP] 9 33 [/SUP], Marcelo Silva[SUP] 9 33 [/SUP], Ramazan Idilman[SUP] 22 [/SUP], Marina Silveira[SUP] 34 [/SUP], Joost P H Drenth[SUP] 27 [/SUP], David N Assis[SUP] 34 [/SUP], Einar Bj?rnsson[SUP] 35 36 [/SUP], James L Boyer[SUP] 34 [/SUP], Pietro Invernizzi[SUP] 10 11 [/SUP], Chyntia Levy[SUP] 18 [/SUP], Thomas D Schiano[SUP] 37 [/SUP], Ezequiel Ridruejo[SUP] 9 33 38 [/SUP], Staffan Wahlin[SUP] 39 [/SUP]
Affiliations
- PMID: 33713486
- DOI: 10.1002/hep.31797
Abstract
Background: Data regarding outcome of Coronavirus disease 2019 (COVID-19) in patients with autoimmune hepatitis (AIH) are lacking.
Patients and methods: We performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated.
Results: We included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe COVID-19 (15.5% vs 20.2% p=0.231) and all-cause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p<0.001; OR 17.46[4.22-72.13]). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19.
Conclusions: This international, multi-center study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in AIH patients. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19, but did lower the risk for new-onset liver injury during COVID-19.
Keywords: Liver transplantation; autoimmunity; immunosuppression; liver failure; mycophenolate mofetil; steroids; tacrolimus.