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.; Rıza Calışkan, A.; Peralta, M.; Gerussi, A.; Massoumi, H.; Catana, A.M.; Torgutalp, M.; Purnak, T.; Rigamonti, C.; Gomez Aldana, A.J.; Khakoo, N.; Kacmaz, H.; Nazal, L.; Frager, S.; Demir, N.; Irak, K.; Ellik, Z.M.; Balaban, Y.; Atay, K.; Eren, F.; Cristoferi, L.; Batıbay, E.; Urzua, Á.; Snijders, R.; Kıyıcı, M.; Akyıldız, M.; Ekin, N.; Carr, R.M.; Harputluoğlu, M.; Hatemi, I.; Mendizabal, M.; Silva, M.; Idilman, R.; Silveira, M.; Drenth, J.P.H.; Assis, D.N.; Björnsson, E.; Boyer, J.L.; Invernizzi, P.; Levy, C.; Schiano, T.D.; Ridruejo, E.; Wahlin, S.
Tarih:
2021
Özet:
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 × 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. © 2021 by the American Association for the Study of Liver Diseases.
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