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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical characteristics and outcomes of COVID-19 in patients with autoimmune hepatitis: A population-based matched cohort study
Arunkumar Krishnan, Ruhee A Patel, Yousaf Bashir Hadi, Diptasree Mukherjee, Sarah Shabih, Shyam Thakkar, Shailendra Singh, Tinsay A Woreta, Saleh A Alqahtani
Arunkumar Krishnan, Ruhee A Patel, Yousaf Bashir Hadi, Sarah Shabih, Shyam Thakkar, Shailendra Singh, Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
Arunkumar Krishnan, Tinsay A Woreta, Saleh A Alqahtani, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Diptasree Mukherjee, Department of Medicine, Apex Institute of Medical Science, Kolkata 700075, West Bengal, India
Saleh A Alqahtani, Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia
Author contributions: Krishnan A conceptualized and designed the research; Alqahtani SA and Woreta TA supervised the project; Krishnan A performed the formal analysis and interpretation of the data; Krishnan A and Patel RA wrote the original draft; Krishnan A, Patel RA, Hadi YB, Mukherjee D, Woreta TA, and Alqahtani SA performed the review and editing of the draft; Krishnan A and Hadi YB performed a critical revision of the manuscript; and all authors revised the manuscript for important intellectual content; and all authors approved the article’s final version, including the authorship list.
Institutional review board statement: TriNetX data have been granted a waiver from the Western institutional review board as a federated network since only aggregated counts and statistical summaries of de-identified information.
Informed consent statement: Not applicable for de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE-Statement checklist of items, and the manuscript was prepared and revised according to the STROBE-Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Arunkumar Krishnan, MBBS, Doctor, Research Fellow, Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, PO Box 9161, 5th Floor HSC, Room 5500, Morgantown, WV 26505, United States. dr.arunkumar.krishnan@gmail.com
Received: September 13, 2022
Peer-review started: September 13, 2022
First decision: October 20, 2022
Revised: October 25, 2022
Accepted: November 14, 2022
Article in press: November 14, 2022
Published online: January 27, 2023
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.
Core Tip: Autoimmune hepatitis (AIH) is a chronic inflammatory disease of the liver of unknown etiology. Patients with AIH may be at increased risk of severe illness from coronavirus disease 2019 (COVID-19) and have poor outcomes due to underlying chronic liver disease (CLD) and ongoing pre-existing immunosuppression therapies. Patients with AIH are associated with increased hospitalization risk, severe disease, and all-cause mortality compared to patients without pre-existing CLDs from the diagnosis of COVID-19. Patients with AIH had a lower risk of several outcomes, including hospitalization, a necessity for critical care, and acute kidney injury, compared to patients with pre-existing CLDs other than AIH.
