Okushin Kazuya, Ikeuchi Kazuhiko, Saito Makoto, Kishida Toshiyuki, Kado Akira, Fujishiro Mitsuhiro, Moriya Kyoji, Yotsuyanagi Hiroshi, Koike Kazuhiko, Tsutsumi Takeya
Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Intern Med. 2025 Aug 1;64(15):2301-2306. doi: 10.2169/internalmedicine.4856-24. Epub 2025 Feb 1.
Objective Although the management of coronavirus disease 2019 (COVID-19) has improved, chemoprevention remains a challenge. We recently identified that ursodeoxycholic acid (UDCA) is associated with subclinical infection with severe acute respiratory syndrome coronavirus, implying a reduction in the severity of COVID-19. We analyzed a large medical database to assess the utility of UDCA in the reduction of COVID-19 severity. Methods This retrospective observational study was conducted using a large-scale healthcare administrative claims database. We extracted data on patients who were diagnosed with either chronic hepatitis B or C. Among them, patients ≥50 years of age diagnosed with COVID-19 before December 2022 were analyzed. Patients were divided into two groups: those with or without a prescription of UDCA. The primary outcome was the in-hospital mortality rate. A propensity score-matching analysis was performed using logistic regression. Results A total of 6,413 patients diagnosed with COVID-19 (UDCA group, n =579; non-UDCA group, n =5,834) were analyzed. The median age was 73.0 (interquartile range, 64.0-81.0) years, and 57.8% of the patients were men. The UDCA group had significantly more complications with liver cirrhosis, hepatocellular carcinoma, type 2 diabetes, and hypertension. The UDCA group had a higher in-hospital mortality rate than the non-UDCA group, even after propensity score matching (7.4% vs. 4.3%, p=0.03), whereas there was no difference in the risks of hospitalization, oxygen therapy, or ventilation. Conclusion Although the observed increase in mortality among UDCA users could have been due to unmeasured confounding factors, UDCA did not reduce the severity of COVID-19 in viral hepatitis patients.
目的 尽管2019冠状病毒病（COVID-19）的管理已有所改善，但化学预防仍然是一项挑战。我们最近发现，熊去氧胆酸（UDCA）与严重急性呼吸综合征冠状病毒的亚临床感染有关，这意味着COVID-19的严重程度会降低。我们分析了一个大型医疗数据库，以评估UDCA在降低COVID-19严重程度方面的效用。方法 这项回顾性观察性研究使用了一个大规模的医疗保健行政索赔数据库。我们提取了被诊断为慢性乙型或丙型肝炎患者的数据。其中，分析了2022年12月之前被诊断为COVID-19的≥50岁患者。患者分为两组：接受或未接受UDCA处方的患者。主要结局是住院死亡率。使用逻辑回归进行倾向评分匹配分析。结果 共分析了6413例被诊断为COVID-19的患者（UDCA组，n = 579；非UDCA组，n = 5834）。中位年龄为73.0（四分位间距，64.0 - 81.0）岁，57.8%的患者为男性。UDCA组肝硬化、肝细胞癌、2型糖尿病和高血压的并发症明显更多。即使在倾向评分匹配后，UDCA组的住院死亡率也高于非UDCA组（7.4%对4.3%，p = 0.03），而住院、氧疗或通气风险没有差异。结论 尽管观察到的UDCA使用者死亡率增加可能是由于未测量的混杂因素，但UDCA并未降低病毒性肝炎患者的COVID-19严重程度。
