Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An
Title:
Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An;
International Multicenter Study
Efe, C; Dhanasekaran, R; Lammert, C; Ebik, B; Higuera-de la Tijera, F; Aloman, C; Caliskan, AR; Peralta, M; Gerussi, A; Massoumi, H; Catana, AM; Torgutalp, M; Purnak, T; Rigamonti, C; Aldana, AJG; Khakoo, N; Kacmaz, H; Nazal, L; Frager, S; Demir, N; Irak, K; Ellik, ZM; Balaban, Y; Atay, K; Eren, F; Cristoferi, L; Batibay, E; Urzua, A; Snijders, R; Kiyici, M; Akyildiz, M; Ekin, N; Carr, RM; Harputluoglu, M; Hatemi, I; Mendizabal, M; Silva, M; Idilman, R; Silveira, M; Drenth, JPH; Assis, DN; Bjornsson, E; Boyer, JL; Invernizzi, P; Levy, C; Schiano, TD; Ridruejo, E; Wahlin, S
Date:
2021
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.
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