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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
ARTICLE HIGHLIGHTS
Research background
Severe illness and clinical outcomes can directly correlate with the underlying comorbidities of patients infected with coronavirus disease 2019 (COVID-19), including patients with autoimmune diseases. However, the clinical course of COVID-19 in patients with autoimmune hepatitis (AIH) is still not well studied.
Research motivation
AIH is a chronic inflammatory liver disease of unknown etiology in which autoimmune-mediated factors against hepatocytes are thought to play a key role. Patients with AIH may be at increased risk of severe illness from COVID-19 and have poor outcomes due to underlying chronic liver disease (CLD) and ongoing pre-existing immunosuppression therapies. Notably, there is a wide research gap in the perceived impact of COVID-19 on patients with AIH due to a high degree of heterogeneity in the existing literature.
Research objectives
This study aimed to evaluate the impact of pre-existing AIH on the clinical outcomes of patients with COVID-19.
Research methods
A population-based, multicenter, propensity score-matched cohort study included 375 patients with AIH, 1647915 patients with non-CLD, and 15790 patients with non-AIH CLD with COVID-19 infection. To reduce confounding effects, we performed a 1:1 propensity score matching with each patient in the main group to a patient in the control group. The primary outcome was all-cause mortality at 60 d, and secondary outcomes were hospitalization rate, need for critical care, severe disease, mechanical ventilation, and acute kidney injury (AKI) at 30 d.
Research results
Patients with AIH had an increased risk of all-cause mortality [risk ratio (RR) = 2.22; 95% confidence interval (CI): 1.07-4.61], hospitalization rate (RR = 1.78), and severe disease (RR = 1.98) compared to the non-CLD controls. However, compared to the non-AIH CLD group, patients in the AIH cohort had a lower risk of hospitalization rate (RR = 0.72), critical care (RR = 0.50), and AKI (RR = 0.56).
Research conclusions
This multicenter, propensity score-matched cohort study reveals that patients with AIH are at risk of worse COVID-19 outcomes than those without pre-existing CLD. However, patients with AIH were not at increased risk of COVID-19 adverse outcomes compared to matched patients with other causes of CLD.
Research perspectives
Further studies with long-term follow-up of these patients are needed to understand the long-term impact of COVID-19 on the liver and elucidate the pathogenic mechanisms among patients with AIH.
