Published online Jan 27, 2023. doi: 10.4254/wjh.v15.i1.68
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
Processing time: 124 Days and 13.4 Hours
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.
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.
This study aimed to evaluate the impact of pre-existing AIH on the clinical outcomes of patients with COVID-19.
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.
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).
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.
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.