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Clinical characteristics and outcomes of COVID-19 in patients with autoimmune hepatitis: A population-based matched
Arunkumar Krishnan1,2, Ruhee A Patel1, Yousaf Bashir Hadi1
1Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States.
Insights
Patients with autoimmune hepatitis (AIH) face higher risks of severe COVID-19, including increased mortality and hospitalization, compared to those without chronic liver disease. However, their outcomes are comparable to patients with other chronic liver diseases.
Area of Science:
- Hepatology
- Immunology
- Infectious Diseases
Background:
- Autoimmune hepatitis (AIH) patients require long-term immunosuppression, potentially increasing COVID-19 severity.
- Limited population-level data exists on AIH and severe COVID-19 outcomes.
Purpose of the Study:
- To assess the impact of pre-existing autoimmune hepatitis (AIH) on COVID-19 clinical outcomes.
- Compare COVID-19 outcomes in AIH patients against non-chronic liver disease and non-AIH chronic liver disease cohorts.
Main Methods:
- Population-based, multicenter, propensity score-matched cohort study.
- Compared COVID-19 outcomes in 375 AIH patients against matched non-CLD and non-AIH CLD controls.
- Primary outcome: all-cause mortality; secondary outcomes: hospitalization, critical care, severe disease, mechanical ventilation, AKI.
Main Results:
- AIH patients had increased mortality (RR=2.22), hospitalization (RR=1.78), and severe disease (RR=1.98) versus non-CLD.
- AIH patients showed lower hospitalization (RR=0.72), critical care (RR=0.50), and AKI (RR=0.56) versus non-AIH CLD.
- Risk ratios and confidence intervals were calculated for all outcomes.
Conclusions:
- Autoimmune hepatitis (AIH) is linked to increased hospitalization, severe disease, and mortality in COVID-19 patients compared to those without chronic liver disease.
- AIH patients do not face worse COVID-19 outcomes compared to individuals with other forms of chronic liver disease.
Background:
Patients with autoimmune hepatitis (AIH) require life-long immunosuppressive agents that may increase the risk of poor coronavirus disease 2019 (COVID-19) outcomes. There is a paucity of large data at the population level to assess whether patients with AIH have an increased risk of severe diseases.
Aim:
To evaluate the impact of pre-existing AIH on the clinical outcomes of patients with COVID-19.
Methods:
We conducted a population-based, multicenter, propensity score-matched cohort study with consecutive adult patients (≥ 18 years) diagnosed with COVID-19 using the TriNeTx research network platform. The outcomes of patients with AIH (main group) were compared to a propensity score-matched cohort of patients: (1) Without chronic liver disease (CLD); and (2) Patients with CLD except AIH (non-AIH CLD) control groups. Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects. The primary outcome was all-cause mortality, and secondary outcomes were hospitalization rate, need for critical care, severe disease, mechanical ventilation, and acute kidney injury (AKI). For each outcome, the risk ratio (RR) and confidence intervals (CI) were calculated to compare the association of AIH with the outcome.
Results:
We identified 375 patients with AIH, 1647915 patients with non-CLD, and 15790 patients with non-AIH CLD with COVID-19 infection. Compared to non-CLD patients, the AIH cohort had an increased risk of all-cause mortality (RR = 2.22; 95%CI: 1.07-4.61), hospitalization rate (RR = 1.78; 95%CI: 1.17-2.69), and severe disease (RR = 1.98; 95%CI: 1.19-3.26). The AIH cohort had a lower risk of hospitalization rate (RR = 0.72; 95%CI: 0.56-0.92), critical care (RR = 0.50; 95%CI: 0.32-0.79), and AKI (RR = 0.56; 95%CI: 0.35-0.88) compared to the non-AIH CLD patients.
Conclusion:
Patients with AIH are associated with increased hospitalization risk, severe disease, and all-cause mortality compared to patients without pre-existing CLD from the diagnosis of COVID-19. However, patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD.
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