COVID-19 患者的结局：一项国际多中心研究。
Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study.
机构信息
Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA.
出版信息
Hepatology. 2021 Jun;73(6):2099-2109. doi: 10.1002/hep.31797.
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.
背景和目的
目前缺乏关于 COVID-19 患者自身免疫性肝炎（AIH）结局的数据。
方法和结果
我们对来自欧洲和美洲 34 个中心的 AIH 和 COVID-19 患者进行了回顾性研究。我们分析了与 COVID-19 严重结局相关的因素，这些结局定义为需要机械通气、入住重症监护病房和/或死亡。将 AIH 患者的结局与未患有 AIH 但患有慢性肝脏疾病（CLD）和 COVID-19 的倾向评分匹配队列的患者进行比较。还评估了 COVID-19 期间新发肝损伤（丙氨酸氨基转移酶＞2 倍正常值上限）的频率和临床意义。我们纳入了 110 名 AIH 患者（80%为女性），COVID-19 诊断时的中位年龄为 49（18-85）岁。89 名患者中有 37.1%（33/89）出现新发肝损伤。抗病毒药物的使用与肝损伤相关（P=0.041；比值比，3.36；95%置信区间，1.05-10.78），而 COVID-19 期间继续免疫抑制与较低的肝损伤发生率相关（P=0.009；比值比，0.26；95%置信区间，0.09-0.71）。AIH 和非 AIH CLD 的 COVID-19 严重结局（15.5%与 20.2%，P=0.231）和全因死亡率（10%与 11.5%，P=0.852）的发生率无差异。肝硬化是 AIH 患者 COVID-19 严重结局的独立预测因素（P＜0.001；比值比，17.46；95%置信区间，4.22-72.13）。COVID-19 期间继续免疫抑制或存在肝损伤与 COVID-19 严重结局无关。
结论
这项国际多中心研究表明，与其他 CLD 病因相比，AIH 患者 COVID-19 结局无恶化风险。肝硬化是 AIH 患者 COVID-19 严重结局的最强预测因素。COVID-19 期间维持免疫抑制与 COVID-19 严重结局风险增加无关，但可降低 COVID-19 期间新发肝损伤的风险。
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