SARS-CoV-2 infection in patients with autoimmune hepatitis
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SARS-CoV-2 infection in patients with autoimmune hepatitis. / Marjot, Thomas; Buescher, Gustav; Sebode, Marcial; Barnes, Eleanor; Barritt, Alfred S; Armstrong, Matthew J; Baldelli, Luke; Kennedy, James; Mercer, Carolyn; Ozga, Ann-Kathrin; Casar, Christian; Schramm, Christoph; Moon, Andrew M; Webb, Gwilym J; Lohse, Ansgar W; contributing Members and Collaborators of ERN RARE-LIVER / COVID-Hep / SECURE-Cirrhosis.
In: J HEPATOL, Vol. 74, No. 6, 06.2021, p. 1335-1343.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - SARS-CoV-2 infection in patients with autoimmune hepatitis
AU - Marjot, Thomas
AU - Buescher, Gustav
AU - Sebode, Marcial
AU - Barnes, Eleanor
AU - Barritt, Alfred S
AU - Armstrong, Matthew J
AU - Baldelli, Luke
AU - Kennedy, James
AU - Mercer, Carolyn
AU - Ozga, Ann-Kathrin
AU - Casar, Christian
AU - Schramm, Christoph
AU - Moon, Andrew M
AU - Webb, Gwilym J
AU - Lohse, Ansgar W
AU - contributing Members and Collaborators of ERN RARE-LIVER / COVID-Hep / SECURE-Cirrhosis
N1 - Copyright © 2021. Published by Elsevier B.V.
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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.
U2 - 10.1016/j.jhep.2021.01.021
DO - 10.1016/j.jhep.2021.01.021
M3 - SCORING: Journal article
C2 - 33508378
VL - 74
SP - 1335
EP - 1343
JO - J HEPATOL
JF - J HEPATOL
SN - 0168-8278
IS - 6
ER -