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Multicenter Study
. 2021 Jun;73(6):2099-2109.
doi: 10.1002/hep.31797.

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

Cumali Efe  1 , Renumathy Dhanasekaran  2 , Craig Lammert  3 , Berat Ebik  4 , Fatima Higuera-de la Tijera  5 , Costica Aloman  6 , Ali Rıza Calışkan  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   17 , Andres Jose Gomez Aldana  18 , Nidah Khakoo  19 , Hüseyin Kacmaz  7 , Leyla Nazal  20 , Shalom Frager  12 , Nurhan Demir  21 , Kader Irak  22 , Zeynep Melekoğlu Ellik  23 , Yasemin Balaban  24 , Kadri Atay  25 , Fatih Eren  26 , Laura Cristoferi  10   11 , Ersin Batıbay  1 , Álvaro Urzua  27 , Romee Snijders  28   29 , Murat Kıyıcı  30 , Murat Akyıldız  31 , Nazım Ekin  4 , Rotonya M Carr  32 , Murat Harputluoğlu  33 , Ibrahim Hatemi  34 , Manuel Mendizabal  9   35 , Marcelo Silva  9   35 , Ramazan Idilman  23 , Marina Silveira  36 , Joost P H Drenth  28   29 , David N Assis  36 , Einar Björnsson  37   38 , James L Boyer  36 , Pietro Invernizzi  10   11 , Chyntia Levy  19 , Thomas D Schiano  39 , Ezequiel Ridruejo  9   34   40 , Staffan Wahlin  41
Affiliations
Multicenter Study

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

Cumali Efe et al. Hepatology. 2021 Jun.

Erratum in

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 × 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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Figures

FIG. 1
FIG. 1
Study flowchart for patient inclusion.
FIG. 2
FIG. 2
Clinical outcomes of COVID‐19 in patients with AIH compared to non‐AIH CLD. All‐cause mortality (10% versus 11.5%), severe COVID‐19 (15.5% versus 20.2%), need for supplemental oxygen (38.2% versus 42.2%), and hospitalization (46.4% versus 50%). P = nonsignificant for all comparisions. Abbreviation: ns, nonsignificant.
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Comment in

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