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

Cumali Efe; Renumathy Dhanasekaran; Craig Lammert; Berat Ebik; Fatima Higuera-de la Tijera; Costica Aloman; Ali Rıza Calışkan; Mirta Peralta; Alessio Gerussi; Hatef Massoumi; Andreea M. Catana; Murat Torgutalp; Tugrul Purnak; Cristina Rigamonti; Andres Jose Gomez Aldana; Nidah Khakoo; Hüseyin Kacmaz; Leyla Nazal; Shalom Frager; Nurhan Demir; Kader Irak; Zeynep Melekoğlu Ellik; Yasemin Balaban; Kadri Atay; Fatih Eren; Laura Cristoferi; Ersin Batıbay; Álvaro Urzua; Romee Snijders; Murat Kıyıcı; Murat Akyıldız; Nazım Ekin; Rotonya M. Carr; Murat Harputluoğlu; Ibrahim Hatemi; Manuel Mendizabal; Marcelo Silva; Ramazan Idilman; Marina Silveira; Joost P.H. Drenth; David N. Assis; Einar Björnsson; James L. Boyer; Pietro Invernizzi; Chyntia Levy; Thomas D. Schiano; Ezequiel Ridruejo; Staffan Wahlin

doi:10.1002/hep.31797

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

Cumali Efe, Renumathy Dhanasekaran, Craig Lammert, Berat Ebik, Fatima Higuera-de la Tijera, Costica Aloman, Ali Rıza Calışkan, Mirta Peralta, Alessio Gerussi, Hatef Massoumi, Andreea M. Catana, Murat Torgutalp, Tugrul Purnak, Cristina Rigamonti, Andres Jose Gomez Aldana, Nidah Khakoo, Hüseyin Kacmaz, Leyla Nazal, Shalom Frager, Nurhan DemirKader Irak, Zeynep Melekoğlu Ellik, Yasemin Balaban, Kadri Atay, Fatih Eren, Laura Cristoferi, Ersin Batıbay, Álvaro Urzua, Romee Snijders, Murat Kıyıcı, Murat Akyıldız, Nazım Ekin, Rotonya M. Carr, Murat Harputluoğlu, Ibrahim Hatemi, Manuel Mendizabal, Marcelo Silva, Ramazan Idilman, Marina Silveira, Joost P.H. Drenth, David N. Assis, Einar Björnsson, James L. Boyer, Pietro Invernizzi, Chyntia Levy, Thomas D. Schiano, Ezequiel Ridruejo, Staffan Wahlin

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English (US)
Pages (from-to)	2099-2109
Number of pages	11
Journal	Hepatology
Volume	73
Issue number	6
DOIs	https://doi.org/10.1002/hep.31797
State	Published - Jun 2021
Externally published	Yes

ASJC Scopus subject areas

Hepatology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/hep.31797

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Efe, C., Dhanasekaran, R., Lammert, C., Ebik, B., Higuera-de la Tijera, F., Aloman, C., Rıza Calışkan, A., Peralta, M., Gerussi, A., Massoumi, H., Catana, A. M., Torgutalp, M., Purnak, T., Rigamonti, C., Gomez Aldana, A. J., Khakoo, N., Kacmaz, H., Nazal, L., Frager, S., ... Wahlin, S. (2021). Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study. Hepatology, 73(6), 2099-2109. https://doi.org/10.1002/hep.31797

Efe, C, Dhanasekaran, R, Lammert, C, Ebik, B, Higuera-de la Tijera, F, Aloman, C, Rıza Calışkan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, AM, Torgutalp, M, Purnak, T, Rigamonti, C, Gomez Aldana, AJ, Khakoo, N, Kacmaz, H, Nazal, L, Frager, S, Demir, N, Irak, K, Ellik, ZM, Balaban, Y, Atay, K, Eren, F, Cristoferi, L, Batıbay, E, Urzua, Á, Snijders, R, Kıyıcı, M, Akyıldız, M, Ekin, N, Carr, RM, Harputluoğlu, M, Hatemi, I, Mendizabal, M, Silva, M, Idilman, R, Silveira, M, Drenth, JPH, Assis, DN, Björnsson, E, Boyer, JL, Invernizzi, P, Levy, C, Schiano, TD, Ridruejo, E & Wahlin, S 2021, 'Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study', Hepatology, vol. 73, no. 6, pp. 2099-2109. https://doi.org/10.1002/hep.31797

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title = "Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study",

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.",

author = "Cumali Efe and Renumathy Dhanasekaran and Craig Lammert and Berat Ebik and {Higuera-de la Tijera}, Fatima and Costica Aloman and {Rıza Calı{\c s}kan}, Ali and Mirta Peralta and Alessio Gerussi and Hatef Massoumi and Catana, {Andreea M.} and Murat Torgutalp and Tugrul Purnak and Cristina Rigamonti and {Gomez Aldana}, {Andres Jose} and Nidah Khakoo and H{\"u}seyin Kacmaz and Leyla Nazal and Shalom Frager and Nurhan Demir and Kader Irak and Ellik, {Zeynep Melekoğlu} and Yasemin Balaban and Kadri Atay and Fatih Eren and Laura Cristoferi and Ersin Batıbay and {\'A}lvaro Urzua and Romee Snijders and Murat Kıyıcı and Murat Akyıldız and Nazım Ekin and Carr, {Rotonya M.} and Murat Harputluoğlu and Ibrahim Hatemi and Manuel Mendizabal and Marcelo Silva and Ramazan Idilman and Marina Silveira and Drenth, {Joost P.H.} and Assis, {David N.} and Einar Bj{\"o}rnsson and Boyer, {James L.} and Pietro Invernizzi and Chyntia Levy and Schiano, {Thomas D.} and Ezequiel Ridruejo and Staffan Wahlin",

note = "Publisher Copyright: {\textcopyright} 2021 by the American Association for the Study of Liver Diseases.",

year = "2021",

month = jun,

doi = "10.1002/hep.31797",

language = "English (US)",

volume = "73",

pages = "2099--2109",

journal = "Hepatology",

issn = "0270-9139",

publisher = "John Wiley and Sons Ltd",

number = "6",

}

TY - JOUR

T1 - Outcome of COVID-19 in Patients With Autoimmune Hepatitis

T2 - An International Multicenter Study

AU - Efe, Cumali

AU - Dhanasekaran, Renumathy

AU - Lammert, Craig

AU - Ebik, Berat

AU - Higuera-de la Tijera, Fatima

AU - Aloman, Costica

AU - Rıza Calışkan, Ali

AU - Peralta, Mirta

AU - Gerussi, Alessio

AU - Massoumi, Hatef

AU - Catana, Andreea M.

AU - Torgutalp, Murat

AU - Purnak, Tugrul

AU - Rigamonti, Cristina

AU - Gomez Aldana, Andres Jose

AU - Khakoo, Nidah

AU - Kacmaz, Hüseyin

AU - Nazal, Leyla

AU - Frager, Shalom

AU - Demir, Nurhan

AU - Irak, Kader

AU - Ellik, Zeynep Melekoğlu

AU - Balaban, Yasemin

AU - Atay, Kadri

AU - Eren, Fatih

AU - Cristoferi, Laura

AU - Batıbay, Ersin

AU - Urzua, Álvaro

AU - Snijders, Romee

AU - Kıyıcı, Murat

AU - Akyıldız, Murat

AU - Ekin, Nazım

AU - Carr, Rotonya M.

AU - Harputluoğlu, Murat

AU - Hatemi, Ibrahim

AU - Mendizabal, Manuel

AU - Silva, Marcelo

AU - Idilman, Ramazan

AU - Silveira, Marina

AU - Drenth, Joost P.H.

AU - Assis, David N.

AU - Björnsson, Einar

AU - Boyer, James L.

AU - Invernizzi, Pietro

AU - Levy, Chyntia

AU - Schiano, Thomas D.

AU - Ridruejo, Ezequiel

AU - Wahlin, Staffan

PY - 2021/6

Y1 - 2021/6

N2 - 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.

AB - 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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JO - Hepatology

JF - Hepatology

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ER -

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

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