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

• Autores: Efe, Cumali; Dhanasekaran, Renumathy; Lammert, Craig; Ebik, Berat; Higuera de la Tijera, Fatima; Aloman, Costica; Rıza Calışkan, Ali; Peralta, Mirta; Gerussi, Alessio; Massoumi, Hatef; Catana, Andreea M.; Torgutalp, Murat; Purnak, Tugrul; Rigamonti, Cristina; Gomez Aldana, Andres Jose; Khakoo, Nidah; Kacmaz, Hüseyin; Nazal, Leyla; Frager, Shalom; Demir, Nurhan; Irak, Kader; Ellik, Zeynep Melekoğlu; Balaban, Yasemin; Atay, Kadri; Eren, Fatih; Cristoferi, Laura; Batibay, Ersin; Urzua, Álvaro; Snijders, Romee; Ridruejo, Ezequiel
• Año de publicación: 2021
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: liver; AIH; COVID-19
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

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.
Fil: Efe, Cumali. Harran University Hospital; Turquía
Fil: Dhanasekaran, Renumathy. University of Stanford; Estados Unidos
Fil: Lammert, Craig. University School of Medicine; Estados Unidos
Fil: Ebik, Berat. Gazi Yaşargil Education and Research Hospital; Turquía
Fil: Higuera de la Tijera, Fatima. Hospital General de México; México
Fil: Aloman, Costica. Rush University Medical Center; Estados Unidos
Fil: Rıza Calışkan, Ali. Adıyaman University; Turquía
Fil: Peralta, Mirta. Latin American Liver Research Educational And Awareness Network; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina
Fil: Gerussi, Alessio. University of Milano Bicocca; Italia. San Gerardo Hospital; Italia
Fil: Massoumi, Hatef. Montefiore Medical Center; Estados Unidos
Fil: Catana, Andreea M.. Harvard Medical School; Estados Unidos
Fil: Torgutalp, Murat. Universitätsmedizin Berlin; Alemania
Fil: Purnak, Tugrul. McGovern Medical School; Estados Unidos
Fil: Rigamonti, Cristina. Azienda Ospedaliera Maggiore Della Carita Di Novara; Italia. Università del Piemonte Orientale; Italia
Fil: Gomez Aldana, Andres Jose. Universidad de los Andes; Colombia
Fil: Khakoo, Nidah. University of Miami; Estados Unidos
Fil: Kacmaz, Hüseyin. Adıyaman University; Turquía
Fil: Nazal, Leyla. Clínica Las Condes; Chile
Fil: Frager, Shalom. Montefiore Medical Center; Estados Unidos
Fil: Demir, Nurhan. Haseki Training and Research Hospita; Turquía
Fil: Irak, Kader. SBU Kanuni Sultan Süleyman Training and Research Hospital; Turquía
Fil: Ellik, Zeynep Melekoğlu. Ankara University Medical Faculty; Turquía
Fil: Balaban, Yasemin. Hacettepe University; Turquía
Fil: Atay, Kadri. Mardin State Hospital; Turquía
Fil: Eren, Fatih. Ordu State Hospital; Turquía
Fil: Cristoferi, Laura. University of Milano Bicocca; Italia. San Gerardo Hospital; Italia
Fil: Batibay, Ersin. Harran University Hospital; Turquía
Fil: Urzua, Álvaro. Universidad de Chile. Facultad de Medicina.; Chile
Fil: Snijders, Romee. Radboud University Medical Center; Países Bajos
Fil: Ridruejo, Ezequiel. Latin American Liver Research Educational and Awareness Network; Argentina. Cerrahpaşa School of Medicine; Turquía. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina