SARS-CoV-2 infection in patients with autoimmune hepatitis.
Marjot T., Buescher G., Sebode M., Barnes E., Barritt AS., Armstrong MJ., Baldelli L., Kennedy J., Mercer C., Ozga A-K., Casar C., Schramm C., contributing Members and Collaborators of ERN RARE-LIVER / COVID-Hep / SECURE-Cirrhosis None.
<h4>Background</h4>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).<h4>Methods</h4>Data for patients with AIH and SARS-CoV-2 infection were combined from three international reporting registries and outcomes were compared to those with chronic liver disease of other aetiology (non-AIH CLD) and to patients without liver disease (non-CLD).<h4>Results</h4>Between 25<sup>th</sup> March and 24<sup>th</sup> October 2020, data were collected for 932 patients with CLD and SARS-CoV-2 infection including 70 with autoimmune hepatitis (AIH). Fifty-eight (83%) of AIH patients were taking one or more immunosuppressive drug. There were no differences in rates of major outcomes between AIH and non-AIH CLD including hospitalization (76% vs 85%; p= 0.06), ICU 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 (OR 2.16/10 years; 1.07-3.81), Child-Turcotte-Pugh (CTP) class B (OR 42.48; 4.40-409.53), and CTP-C cirrhosis (OR 69.30; 2.83-1694.50), but not use of immunosuppression. Propensity score matched (PSM) analysis comparing AIH with non-AIH CLD demonstrated no increased risk adverse outcomes including death (+3.2%; -9.2%-15.7%). PSM analysis of AIH versus non-CLD patients (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%).<h4>Conclusion</h4>AIH patients were not at increased risk of adverse outcomes despite immunosuppressive treatment compared to other causes of CLD and to matched cases without liver disease.