SARS-CoV-2 infection in patients with autoimmune hepatitis

JOURNAL OF HEPATOLOGY

卷:74

Article

Marjot, Thomas¹  Buescher, Gustav^2,3  Sebode, Marcial^2,3  Barnes, Eleanor¹  Barritt, A. Sidney⁴  Armstrong, Matthew J.⁵  Baldelli, Luke⁶  Kennedy, James¹  Mercer, Carolyn¹  Ozga, Ann-Kathrin⁷  Casar, Christian^2,3  Schramm, Christoph^2,3,8  Moon, Andrew M.⁴  Webb, Gwilym J.⁹  Lohse, Ansgar W.^2,3 

[1] Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Oxford Liver Unit, Translat Gastroenterol Unit, Oxford OX3 9DU, England

[2] Univ Med Ctr Hamburg Eppendorf, Dept Med, Martinistr 52, D-20246 Hamburg, Germany

[3] European Reference Network Hepatol Dis ERN RARE L, Hamburg, Germany

[4] Univ N Carolina, Div Gastroenterol & Hepatol, Chapel Hill, NC 27515 USA

[5] Queen Elizabeth Hosp Birmingham, Liver Unit, Birmingham, W Midlands, England

[6] Univ N Carolina, Dept Med, Chapel Hill, NC 27515 USA

[7] Univ Med Ctr Hamburg Eppendorf, Inst Med Biometry & Epidemiol, Hamburg, Germany

[8] Univ Med Ctr Hamburg Eppendorf, Martin Zeitz Ctr Rare Dis, Hamburg, Germany

[9] Cambridge Univ Hosp, Addenbrookes Hosp, Cambridge Liver Unit, Cambridge, England

关键词: autoimmune hepatitis;    SARS-CoV-2;    COVID-19;    immunosuppression;    coronavirus;    liver disease;   

DOI  :  10.1016/j.jhep.2021.01.021

来源: Elsevier

【 摘 要 】

Background & Aims: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) continues to have a devastating impact across the globe. However, little is known about the disease course in patients with autoimmune hepatitis (AIH). Methods: Data for patients with AIH and SARS-CoV-2 infection were combined from 3 international reporting registries and outcomes were compared to those in patients with chronic liver disease of other aetiology (non-AIH CLD) and to patients without liver disease (non-CLD). Results: Between 25th March and 24th October 2020, data were collected for 932 patients with CLD and SARS-CoV-2 infection including 70 with autoimmune hepatitis (AIH). Fifty-eight (83%) patients with AIH were taking >= 1 immunosuppressive drug. There were no differences in rates of major outcomes between patients with AIH and non-AIH CLD, including hospitalization (76% vs. 85%; p = 0.06), intensive care unit admission (29% vs. 23%; p = 0.240), and death (23% vs. 20%; p = 0.643). Factors associated with death within the AIH cohort included age (odds ratio [OR] 2.16/10 years; 1.07-3.81), and Child-Pugh class B (OR 42.48; 4.40-409.53), and C (OR 69.30; 2.83-1694.50) cirrhosis, but not use of immunosuppression. Propensity score matched (PSM) analysis comparing patients with AIH with non-AIH CLD demonstrated no increased risk of adverse outcomes including death (+3.2%; -9.2%-15.7%). PSM analysis of patients with AIH vs. non-CLD (n = 769) demonstrated increased risk of hospitalization with AIH (+18.4%; 5.6-31.2%), but equivalent risk of all other outcomes including death (+3.2%; -9.1%-15.6%). Conclusion: Patients with AIH were not at increased risk of adverse outcomes despite immunosuppressive treatment compared to other causes of CLD and to matched cases without liver disease. Lay summary: Little is known about the outcomes of COVID-19 in patients with autoimmune hepatitis (AIH), a rare chronic inflammatory liver disease. This study combines data from 3 large registries to describe the course of COVID-19 in this patient group. We show that AIH patients do not appear to have an increased risk of death from COVID-19 compared to patients with other forms of liver disease and compared to patients without liver disease, despite the use of medications which suppress the immune system. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

【 授权许可】

Free