Behaviors, symptoms, and outcomes of North American patients with autoimmune hepatitis during the COVID-19 pandemic

Abstract

The management of patients with autoimmune hepatitis (AIH) in the era of SARS-CoV-2 is challenging given minimal published clinical data. We used a large cohort of patients with AIH across the USA to investigate the differences in known risk factors for severe SARS-CoV-2 and AIH characteristics among patients who experienced symptoms consistent with COVID-19 illness versus those who did not. Additionally, we explored the effect of living through the SARS-CoV-2 pandemic on the extrahepatic symptoms and behaviors of patients with AIH. An invitation to complete a COVID-19-specific questionnaire was publicized in well-established social media cohorts of patients with AIH. Eligibility criteria were age ≥18 years, US residency, and an AIH diagnosis by a physician. A total of 420 individuals were eligible for the study. Symptoms consistent with COVID-19 were reported in 11% (n=48) with 3 patients requiring hospitalizations. Body mass index (BMI) >40 kg/m2 (23% vs 10%, p=0.01) and exposure to house (33% vs 3%, p=0.0001) or work (38% vs 17%, p=0.02) contacts with COVID-19 were factors found higher in those with symptoms. Cirrhosis or steroid use or immunosuppression was not significantly different between symptomatic and non-symptomatic groups. Worsening fatigue (45% vs 30%, p=0.06), anxiety (89% vs 70%, p=0.08), and itch (40% vs 18%, p=0.03) were more common among those reporting COVID-19 symptoms compared with those without. BMI >40 kg/m2 and exposure to contacts with COVID-19 illness but not cirrhosis or immunosuppression were associated with increased risk of COVID-19 illness in patients with AIH.

Management of COVID-19 patients with chronic liver diseases and liver transplants

“… 30 (52%) patients with AIH were on combined immunosuppression with ≥2 agents. VahinVuppalanchi et al [31] N=420 AIH:420 Liver biopsy reported cirrhosis:78 Immune suppressants for the AIH treatment do not increase the risk of severe COVID-19. / / Alessio Gerussi et al [32] N=10 AIH patients:10 Cirrhosis: 4 Decompensated cirrhosis (Child-Pugh B): 6 / 9 patients are still alive and asymptomatic, and 1 (patient 6) died.…”

“…The immune function of autoimmune hepatitis (AIH) patients is passively suppressed, and their liver may be decompensated at the same time, which may have adverse effects on the recovery of COVID-19. Several large multicenter studies have found that COVID-19 patients seemed to have a similar disease process as the general patients among the patients who received immunosuppressive therapy, and immunosuppression may also reduce the risk of new-onset liver injury [29] , [30] , [31] . Reducing immunosuppression in AIH (applicable to other autoimmune diseases) patients during the pandemic may be detrimental, as it may expose individuals to a higher risk of disease recurrence.…”

Changes in Behavior After Vaccination and Opinions Toward Mask Wearing: Thoracic Oncology Patient–Reported Experiences During the COVID-19 Pandemic

“… 15 In addition, a survey of patients with autoimmune hepatitis who are also vulnerable to infection and severe complications due to a suppressed immune system found that a majority of patients would make changes to their behavior like limiting entertainment outside the home, mask wearing, and limiting interactions with family and friends after the strict stay-at-home orders were relaxed. 11 However, these surveys were completed before vaccinations were available.…”

“…10 In a study of patients with autoimmune hepatitis, the authors found that patients with COVID-19 symptoms reported increased fatigue, anxiety, and itch compared with those without symptoms of COVID-19. 11 Furthermore, frequent contacts with the health care system lead to a higher risk of infection. 12 Masks along with social distancing are effective non-pharmaceutical public health interventions to reduce the rate of infection.…”

Thirteen-Year Follow-Up of a Patient with Liver Cirrhosis Resulting from the Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis: Severe COVID-19 and Liver Transplantation

“…Наиболее уязвимыми для вируса SARS-CoV-2 (группы риска) являлись пациенты с циррозом печени (особенно декомпенсированным), с прогрессирующими хроническими диффузными заболеваниями печени, с аутоиммунными заболеваниями печени (особенно получающие иммуносупрессивную терапию), после трансплантации печени, с гепатоцеллюлярной карциномой, с неалкогольной жировой болезнью печени [6][7][8]. Хотя первичные клинические проявления связаны с поражением легких, в настоящее время признано, что COVID-19 является системным заболеванием, связанным с непредсказуемым иммунным ответом организма человека, приводящим к активации свертывающей системы крови, полиорганной недостаточности и смерти [9][10][11]. Известно, что у пациентов с сопутствующим хроническим паренхиматозным заболеванием печени, в частности декомпенсированным циррозом печени, инфекция COVID-19 может быть ассоциирована с более высоким риском летального исхода [12][13][14][15][16] -летальность достигает более 30 % [8].…”