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 1 , Renumathy Dhanasekaran 2 , Craig Lammert 3 , Berat Ebi 4 , Fatima Higuera-de la Tijera 5 , Costica Aloman 6 , Ali R?za Cal??kan 7 , Mirta Peralta 8 9 , Alessio Gerussi 10 11 , Hatef Massoumi 12 , Andreea M Catana 13 , Murat Torgutalp 14 , Tugrul Purnak 15 , Cristina Rigamonti 16 , Andres Jose Gomez Aldana 17 , Nidah Khakoo 18 , H?seyin Kacmaz 7 , Leyla Nazal 19 , Shalom Frager 12 , Nurhan Demir 20 , Kader Irak 21 , Zeynep Meleko?lu Ellik 22 , Yasemin Balaban 23 , Kadri Atay 24 , Fatih Eren 25 , Laura Cristoferi 10 11 , Ersin Bat?bay 1 , ?lvaro Urzua 26 , Romee Snijders 27 , Murat K?y?c? 28 , Murat Aky?ld?z 29 , Naz?m Ekin 4 , Rotonya M Carr 30 , Murat Harputo?lu 31 , Ibrahim Hatemi 32 , Manuel Mendizabal 9 33 , Marcelo Silva 9 33 , Ramazan Idilman 22 , Marina Silveira 34 , Joost P H Drenth 27 , David N Assis 34 , Einar Bj?rnsson 35 36 , James L Boyer 34 , Pietro Invernizzi 10 11 , Chyntia Levy 18 , Thomas D Schiano 37 , Ezequiel Ridruejo 9 33 38 , Staffan Wahlin 39
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.