Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An

Abstract

Background and Aims Data regarding outcome of COVID-19 in patients with autoimmune hepatitis (AIH) are lacking.

Approach and Results We performed a retrospective study on patients with AIH and COVID-19 from 34 centers 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 patients without AIH but with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase > 2 x the upper limit of normal) during COVID-19 was also evaluated. We included 110 patients with AIH (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; OR, 3.36; 95% CI, 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; 95% CI, 0.09-0.71). The rates of severe COVID-19 (15.5% versus 20.2%, P = 0.231) and all-cause mortality (10% versus 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; 95% CI, 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, multicenter 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 patients with AIH. 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.

C1 [Efe, Cumali; Batibay, Ersin] Harran Univ Hosp, Dept Gastroenterol, Sanliurfa, Turkey.

[Dhanasekaran, Renumathy] Stanford Univ, Div Gastroenterol & Hepatol, Dept Med, Stanford, CA 94305 USA.

[Lammert, Craig] Indiana Univ Sch Med, Dept Med, Indianapolis, IN 46202 USA.

[Ebik, Berat; Ekin, Nazim] Gazi Yasargil Educ & Res Hosp, Dept Gastroenterol, Diyarbakir, Turkey.

[Higuera-de la Tijera, Fatima] Hosp Gen Mexico City, Gastroenterol & Hepatol Unit, Mexico City, DF, Mexico.

[Aloman, Costica] Rush Univ, Med Ctr, Sect Hepatol, Chicago, IL 60612 USA.

[Caliskan, Ali Riza; Kacmaz, Huseyin] Adiyaman Univ, Dept Gastroenterol, Adiyaman, Turkey.

[Peralta, Mirta] Hosp Francisco J Muniz, Hepatol Sect, Buenos Aires, DF, Argentina.

[Peralta, Mirta; Mendizabal, Manuel; Silva, Marcelo; Ridruejo, Ezequiel] Latin Amer Liver Res Educ & Awareness Network, Pilar, Argentina.

[Gerussi, Alessio; Cristoferi, Laura; Invernizzi, Pietro] Univ Milano Bicocca, Dept Med & Surg, Div Gastroenterol, Ctr Autoimmune Liver Dis, Monza, Italy.

[Gerussi, Alessio; Cristoferi, Laura; Invernizzi, Pietro] San Gerardo Hosp, European Reference Network Hepatol Dis ERN Rare L, Monza, Italy.

[Massoumi, Hatef; Frager, Shalom] Montefiore Med Ctr, Dept Med, Bronx, NY 10467 USA.

[Catana, Andreea M.] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Med, Div Gastroenterol Hepatol, Boston, MA 02115 USA.

[Torgutalp, Murat] Charite Univ Med Berlin, Campus Benjamin Franklin, Dept Gastroenterol Infect Dis & Rheumatol, Berlin, Germany.

[Purnak, Tugrul] McGovern Med Sch, Div Gastroenterol Hepatol & Nutr, Houston, TX USA.

[Rigamonti, Cristina] Univ Piemonte Orientale UPO, Dept Translat Med, Novara, Italy.

[Rigamonti, Cristina] AOU Maggiore Carita, Div Internal Med, Novara, Italy.

[Gomez Aldana, Andres Jose] Fdn Santa Fe Bogota, Gastroenterol & Hepatol Unit, Bogota, Colombia.

[Gomez Aldana, Andres Jose] Univ Los Andes, Bogota, Colombia.

[Khakoo, Nidah; Levy, Chyntia] Univ Miami, Miller Sch Med, Div Hepatol, Miami, FL 33136 USA.

[Nazal, Leyla] Clin La Condes, Gastroenterol & Hepatol Unit, Santiago, Chile.

[Demir, Nurhan] Haseki Training & Res Hosp, Dept Gastroenterol, Istanbul, Turkey.

[Irak, Kader] SBU Kanuni Sultan Suleyman Training & Res Hosp, Dept Gastroenterol, Istanbul, Turkey.

[Ellik, Zeynep Melekoglu; Idilman, Ramazan] Ankara Univ, Dept Gastroenterol, Med Fac, Ankara, Turkey.

[Balaban, Yasemin] Hacettepe Univ, Fac Med, Dept Gastroenterol, Ankara, Turkey.

[Atay, Kadri] Mardin State Hosp, Dept Gastroenterol, Mardin, Turkey.

[Eren, Fatih] Ordu State Hosp, Dept Gastroenterol, Ordu, Turkey.

[Urzua, Alvaro] Hosp Clin Univ Chile, Gastroenterol & Hepatol Unit, Santiago, Chile.

[Snijders, Romee; Drenth, Joost P. H.] Radboud Univ Nijmegen, Dept Gastroenterol & Hepatol, Med Ctr, Nijmegen, Netherlands.

[Snijders, Romee; Drenth, Joost P. H.] European Reference Network Hepatol Dis ERN RARE L, Hamburg, Germany.

[Kiyici, Murat] Uludag Univ, Med Fac, Dept Gastroenterol, Bursa, Turkey.

[Akyildiz, Murat] Koc Univ, Dept Gastroenterol, Sch Med, Istanbul, Turkey.

[Carr, Rotonya M.] Univ Penn, Div Gastroenterol, Philadelphia, PA 19104 USA.

[Harputluoglu, Murat] Inonu Univ, Dept Gastroenterol, Sch Med, Malatya, Turkey.

[Hatemi, Ibrahim; Ridruejo, Ezequiel] Cerrahpasa Sch Med, Dept Gastroenterol, Istanbul, Turkey.

[Mendizabal, Manuel; Silva, Marcelo] Hosp Univ Austral, Hepatol & Liver Transplant Unit, Pilar, Argentina.

[Silveira, Marina; Assis, David N.; Boyer, James L.] Yale Sch Med, Dept Med, Sect Digest Dis, New Haven, CT USA.

[Bjornsson, Einar] Landspitali Univ Hosp, Dept Internal Med, Sect Gastroenterol, Reykjavik, Iceland.

[Bjornsson, Einar] Univ Iceland, Fac Med, Reykjavik, Iceland.

[Schiano, Thomas D.] Mt Sinai Med Ctr, Div Liver Dis, New York, NY USA.

[Ridruejo, Ezequiel] Ctr Educ Med & Invest Clin, Dept Med, Hepatol Sect, Buenos Aires, DF, Argentina.

[Wahlin, Staffan] Karolinska Inst, Karolinska Univ Hosp, Dept Upper GI, Hepatol Div, Stockholm, Sweden.