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

• Published in: Journal of investigative medicine Vol. 69; no. 8; pp. 1426 - 1433
• Main Authors: Vuppalanchi, Vahin, Gelow, Kayla, Green, Kelsey, Vuppalanchi, Raj, Lammert, Craig
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA BMJ Publishing Group Ltd 01.12.2021; SAGE Publications; Sage Publications Ltd; BMJ Publishing Group
• Subjects: Age; AIH; Anxiety; autoimmune hepatitis; Body mass index; Coronaviruses; COVID-19; COVID-19 - epidemiology; Diabetes; Disease transmission; Fatigue; Hepatitis; Hepatitis, Autoimmune - epidemiology; Humans; Hypertension; Illnesses; immunosuppression; Immunosuppression Therapy; Infections; Liver Cirrhosis; Liver diseases; Mortality; Original Research; Pandemics; Patients; Polls & surveys; Pruritus; Quality of life; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Shelter in place; Social networks; Transplants & implants; United States - epidemiology; United States; Indiana; United States > US; Europe; COVID-19; AIH; immunosuppression; SARS-CoV-2; autoimmune hepatitis
• ISSN: 1081-5589; 1708-8267
• DOI: 10.1136/jim-2021-001871

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.