Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, European Reference Network on Hepatological Diseases (ERN Rare-Liver), Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Inserm UMR_S938, Saint-Antoine Research Center, Sorbonne University, Paris, France.
J Med Virol. 2024 Jan;96(1):e29418. doi: 10.1002/jmv.29418.
Recent data suggest that ursodeoxycholic acid (UDCA) therapy may reduce susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and even improve clinical outcomes when coronavirus disease-2019 (COVID-19) was diagnosed. However, clinical evidence of UDCA's ability to prevent severe forms of COVID-19 remains limited and contradictory. We evaluated the association between UDCA exposure and the risk of hospitalization for COVID-19 in a large multicenter population of patients with chronic liver disease (CLD) followed during the pandemic period before vaccination. An exposed/unexposed cohort study and a nested case-control study were performed. The primary endpoint was severe COVID-19, defined as SARS-CoV2 infection requiring hospitalization. The secondary endpoint was COVID-19-associated intensive care unit (ICU) admission or death. Adjusted odds ratios (aOR) and their confidence intervals (CI) were determined after controlling for age, gender, comorbidities at risk for COVID-19, severity of CLD, and prior hospitalizations. A total of 10 147 patients, including 1322 exposed and 8825 not exposed to UDCA, totaling 21 867 person-years of follow-up, were included in the cohort analysis, while 88 patients hospitalized for COVID-19 and 840 matched controls were eligible for the nested case-control analysis. In both analyses, exposure to UDCA was not associated with a significant reduction in the risk of hospitalization for COVID-19, with aOR (95% confidence interval) values of 0.48 (0.20-1.19) and 0.93 (0.26-3.29), respectively. Furthermore, there was no significant reduction in the risk of ICU admission or death. In this large population of patients with CLD, UDCA exposure was not associated with a reduced risk of severe COVID-19.
最近的数据表明，熊去氧胆酸（UDCA）治疗可能降低严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的易感性，甚至在诊断出 2019 年冠状病毒病（COVID-19）时改善临床结局。然而，UDCA 预防 COVID-19 严重形式的能力的临床证据仍然有限且相互矛盾。我们在接种疫苗前大流行期间对患有慢性肝病（CLD）的患者进行了一项多中心队列研究，评估了 UDCA 暴露与 COVID-19 住院风险之间的关联。进行了暴露/未暴露队列研究和巢式病例对照研究。主要终点是严重 COVID-19，定义为需要住院治疗的 SARS-CoV2 感染。次要终点是 COVID-19 相关的重症监护病房（ICU）入住或死亡。在控制年龄、性别、COVID-19 相关的合并症、CLD 的严重程度和既往住院情况后，确定调整后的优势比（aOR）及其置信区间（CI）。队列分析共纳入 10147 例患者，包括 1322 例暴露组和 8825 例未暴露组，共 21867 人年随访，88 例因 COVID-19 住院的患者和 840 例匹配对照符合巢式病例对照分析的条件。在这两项分析中，UDCA 暴露与 COVID-19 住院风险的显著降低无关，aOR（95%置信区间）值分别为 0.48（0.20-1.19）和 0.93（0.26-3.29）。此外，ICU 入住或死亡的风险也没有显著降低。在这项大型 CLD 患者人群中，UDCA 暴露与降低严重 COVID-19 的风险无关。
