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SARS-CoV-2 infection in patients with autoimmune hepatitis
Thomas Marjot1, Gustav Buescher2, Marcial Sebode2
1Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK.
Insights
Patients with autoimmune hepatitis (AIH) taking immunosuppressants did not face worse COVID-19 outcomes. This study found no increased risk of hospitalization or death compared to other chronic liver disease patients or those without liver disease.
Area of Science:
- Hepatology
- Immunology
- Infectious Diseases
Background:
- Autoimmune hepatitis (AIH) is a chronic liver disease with limited data on COVID-19 outcomes.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) pose global health challenges.
Purpose of the Study:
- To investigate the disease course and outcomes of COVID-19 in patients with autoimmune hepatitis.
- To compare outcomes in AIH patients with those having other chronic liver diseases (CLD) and individuals without liver disease.
Main Methods:
- Data from 70 autoimmune hepatitis (AIH) patients with SARS-CoV-2 infection were analyzed from 3 international registries.
- Outcomes were compared between AIH patients (many on immunosuppressants) and non-AIH CLD patients, and non-CLD controls.
- Propensity score matching (PSM) was used for robust comparison of outcomes.
Main Results:
- No significant differences in hospitalization, ICU admission, or death rates were observed between AIH and non-AIH CLD patients.
- Age and cirrhosis severity (Child-Pugh B/C) were associated with death in the AIH cohort, not immunosuppression.
- PSM analysis showed no increased risk of adverse outcomes, including death, for AIH patients compared to non-AIH CLD or non-CLD groups, though hospitalization risk was higher versus non-CLD.
Conclusions:
- Autoimmune hepatitis patients do not face an increased risk of severe COVID-19 outcomes, including death, despite immunosuppressive therapy.
- The findings suggest that standard care and management are effective for AIH patients with COVID-19.
- These results provide crucial insights for managing AIH patients during the COVID-19 pandemic.
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.
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