ABSTRACT
Introduction: Autoimmune hepatitis (AIH) is a relatively rare chronic immune-mediated liver disease, which develops in genetically predisposed individuals following an environmental trigger. A few cases of AIH have been recently reported after the SARS-CoV-2 vaccination. Aims: The aim of this study was to describe clinical-epidemiological profile of a series of adult patients who experienced AIH onset following SARS-CoV-2 vaccination. Materials and Methods: This multicentric observational study collected clinical data of adult patients who had received SARS-CoV-2 vaccination and thereafter were diagnosed with AIH between 03/2021 and 10/2021 in Italy, using an online survey among members of the Italian Association for the study of the Liver (AISF). Results: Among the 12 patients included: 50% were females, median age 62 years (range 32-80), 6 (50%) had preexisting extrahepatic autoimmune disease (3 thyroiditis, 2 rheumatoid arthritis, 1 systemic lupus erythematosus), 7 patients have received Comirnaty (BioNTech/Pfizer) vaccine, 2 Spikevax (Moderna Biotech) and 3 Vaxzevria (AstraZeneca). Ten patients (83%) had acute onset of AIH with transaminase levels ≥10 times the upper limit of normal (ULN, range 13-77 x ULN), 8 (67%) with jaundice (total bilirubin 3.5-18.6 x ULN). At AIH diagnosis (median time from first and second vaccine dose: 48 and 10 days, respectively) median AST was 18 x ULN (range 5-85), ALT 23.8 x ULN (range 7-83), total bilirubin 3.8 x ULN (range 0.6-18.6), alkaline phosphatase 1.3 x ULN (range 0.8-7.1), immunoglobulin G 1.2 x ULN (median 0.8-1.5). Eight (67%) patients had autoantibodies: 6 ANA, 1 SMA, 1 LKM-1. Liver biopsy was typical for AIH in 8 and compatible in 3 patients. After 3 months 58% achieved complete biochemical response to standard immunosuppressive treatment. Conclusion: While intensive vaccination against SARS-CoV-2 continues, the diagnosis of AIH secondary to vaccines should be included in the differential diagnosis in cases of acute hepatitis of unexplained aetiology.
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Background and aims: Solid organ transplant recipients (SOTRs) have been considered as an extremely vulnerable population in respect to SARS-CoV-2 infection. We aimed to assess the incidence and lethality rate of SARS-CoV-2 infection in different organ transplant settings using the liver as a comparator. Methods: In this nationwide population-based study we compared the crude incidence and lethality rates of SARS-CoV-2 infection [95% Bonferroni adjusted CI (Ba-CI)] among Italian LTRs as compared to non-liver SOTRs and to general population. The following independent groups had been compared: Italian general population, all SOTRs, liver transplant recipients (LTRs) and non-Liver SOTRs in area with different incidence of infection. Incidence rate ratio (IRR) and lethality rate ratio (LRR) was assessed. Community risk exposures in transplant settings were assessed. Results: From February 21 to June 22, 2020, there were 450 cases of SARS-CoV-2 infections over 14168 LTRs (n=89) and 29815 non-liver SOTRs (n= 361). A significantly lower risk of infection [IRR 0.56 (Ba-CI 0.34-0.92), 0.45 (Ba-CI 0.26-0.79), 0.52 (Ba-CI 0.36-0.75)] and a lower lethality rate ratio [(LRR 0.61 (Ba-CI 0.23-1.57), 0.37 (0.08-1.76), 0.52 (0.23-1.18] was found among LTRs as compared to non-liver SOTRs in the three areas. Excluding Lombardy, the risk of infection and lethality in LTRs was lower compared to general population. Non-Liver SOTRs showed an increased risk of infection and lethality at all geographic levels compared to general population. No significant difference in the adherence to mitigation policies was found. Conclusions: Liver transplantation was associated with a significantly lower risk of SARS-CoV-2 infection and lethality in respect to non-liver solid organ transplants. A separate evaluation of organ-specific risk stratification analysis and vaccination responses in transplant population is needed.
ABSTRACT
Background : Endothelial damage and hypercoagulability are major players behind the hemostatic derangement in SARS-CoV-2 infection. Aims : In this prospective cohort study of COVID-19 patients, we aimed to assess the role of circulating endothelial activation/damage biomarkers in predicting in-hospital mortality. Methods : Clinical data of COVID-19 patients hospitalized in intensive care (ICU) and non-ICU units at 2 Bergamo (Italy) hospitals from March 23 to May 30, 2020, were analyzed. Markers of endothelium activation including von-Willebrand factor (vWF), soluble thrombomodulin (sTM), and fibrinolytic proteins (t-PA and PAI-1) were measured. Additionally, D-dimer, Fibrinogen, FVIII, nucleosomes, CRP and procalcitonin were assessed. Results : Sixty-three (45 ICU, and 18 non-ICU) patients, with a median age of 62 years were analyzed. Increased plasma levels of Ddimer, FVIII, fibrinogen, nucleosomes, CRP, and procalcitonin were observed in the whole cohort. Extremely elevated vWF levels characterized all patients (highest values in ICU-subjects). Patients with a moderate and severe ARDS (i.e. PaO2/FiO2 ≤200%) have considerably higher vWF and sTM levels, and lower t-PA/PAI-1 values compared to patients in the mild ARDS group (i.e. PaO2/FiO2 >200%). After a median time of 30 days, death occurred in 13 (21%) patients. By multivariable analysis, vWF-activity, neutrophil-count and PaO2/ FiO2 were significantly associated with death. Using these variables, we generated a linear score with 3-risk groups (AUC 0.903) that provided a cumulative incidence of death of 0 % in the low-, 32% in the intermediate-, and 78% in the high-risk group ( P < 0.001). Conclusions : In conclusion, our study provides an extensive overview of the endothelial damage induced by SARSCoV-2 infection in hospitalized patients with virus-induced pneumonia and different degrees of disease severity. In addition, despite the small sample size and the need for the external validation, we could generate an accurate score based on circulating vWF to predicting mortality in severe COVID-19 patients.
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Background: Sars-Cov-2 pneumonia is a pandemic disease with high morbidity and mortality In literature transaminases were frequently found abnormal but their role has not been clarified, particularly in patients with liver disease (LD). Aim of this retrospective study is to explore the role of transaminases on short-term prognosis of hospitalized COVID-19 patients Methods: patients admitted in hospital for respiratory failure due to Sars-Cov-2 were consecutively recruited Primary endpoint: evaluate role of transaminases on disease progression (DP). Secondary endpoints: find possible risk factors for (1) mortality and (2) composite outcome consisting of DP or death Results: 135 patients included Median age was 68 years (IQR 58-74), 33 3% (n=45) were female AST/ ALT at admission and after 7 days were abnormal in about two/thirds of cases CPAP patients had transaminases more frequently abnormal (p=0 01) Transaminases alterations were predictive of DP at univariate analysis In multivariate analysis CRP at day 7 was predictor of DP (OR 3 08 and 1 08) while cardiopathy and ventilation type at admission were significantly associated with death (OR 9.95 and 11.5). Conclusion: This study individuates possible prognostic factors in Sars-Cov-2 pneumonia Transaminases values do not predict DP or death, even if more severe patients have a higher prevalence of transaminases elevation CRP at day 7 is a predictor of DP, while cardiopathy and type of ventilation at admission are predictive factors of short-term mortality.
ABSTRACT
Background: In December 2019, a new contagious disease, named COVID-19 caused by a novel coronavirus (SARSCov- 2) emerged in Wuhan City, China Since February 2020 this disease has also spread to Italy Bergamo, where one of the most active liver transplant (LT) Italian center is located, has been one of the most affected cities by COVID-19 This study aimed to evaluate the impact of COVID-19 in liver transplant patients Methods: From April 1st, 2020, to May 15th, 2020, 660 adult liver transplant recipients were contacted by phone by the medical staff of the Transplant Center at the ASST-Papa Giovanni XXIII-Bergamo The presence of COVID-19 symptoms (fever, cough, dyspnea, asthenia, dysgeusia, anosmia, gastrointestinal complaints and/or myalgia) and contact at risk were investigated Results of RX chest, SARS-Cov-2 nose-swab and hospitalizations, when occurred, were recorded in symptomatic patients Results: Seventy-seven patients (11 7%) reported symptoms related to SARS-Cov-2 infection;patients were primarily males (72 7%), with a median age of 62 9 years (IQR 57 1-69 0) and a median time from LT of 73 6 months (IQR 36 5-135 8) A chest x-rays was performed in 25/77 symptomatic patients (32 5%) and in 17/25 (68 0%) an interstitial pneumonia was found;swabs were performed in 21/77 patients (27 3%) and 17 of them (81 0%) resulted positive Among symptomatic patients, all reported at least two symptoms and in 14 (18 2%) five symptoms were present. Three patients (3.9%) had been hospitalized for transplant-related reasons and 11 patients needed hospitalization because of COVID-19 (14 9%) All hospitalized patients were treated with antibiotics;high dose steroids were added to 8 patients and antiviral therapy (lopinavir/ritonavir) to 4 patients Nine patients (11 7%) needed oxygen therapy One patient died for non-COVID-19 related condition, 2 patients died for COVID-19 (2/76;2 6%) Mortality in hospitalized patients was 21 4% (3/14), COVIDrelated mortality-rate was 15 4% (2/13) and both patients died within one month after LT Conclusion: COVID-19 can affect liver transplant patients, however, in our experience, both the need for hospitalization and deaths do not exceed those observed among the general population.
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Background: Stigma and poor linkage to care, amplified in the setting of the COVID-19 pandemic, are significant barriers for treating hepatitis C (HCV) in vulnerable patients, reducing our ability to implement a rapid test and treat (TnT) strategy with minimal monitoring within a simple patient cascade, as currently available HCV therapies would allow us to do This real-world analysis evaluates our ability to implement this approach in both general (GP) and vulnerable (VP) populations Methods: HCV-infected patients from 32 clinical cohorts in 8 countries treated with sofosbuvir/ velpatasvir without a history of decompensation or prior NS5A-inhibitor exposure were included in this analysis The VP included prisoners, homeless patients and patients with mental disorders Time to treatment (TT) between the most recent HCV RNA measurement and treatment initiation was estimated based on available data Results: A total of 2449 patients were included, 937 in GP (58% males), 1512 (72% males) in VP (59% with mental disorders, 31% homeless, 10% imprisoned) Mean age [standard deviation] was 55 [14] and 50 [14] years in GP and VP respectively Genotype 3 was observed in 35% and 33% respectively, compensated cirrhosis confirmed in 20% and 18% of GP versus VP. The median TT [MTT, interquartile range] was 55 days [23- 107] in GP and 60 days [27-132] in VP The longest MTT of 66 days [32-134] was observed in patients with mental disorders MTT was 63 days [29-149] in prisoners and 27 days [13-71] among the homeless Only 13% of GP and 8% of VP were treated the same day of diagnosis, and 70% of GP and 63% of VP were treated within 3 months In patients with mental disorders only 4% were treated the same day of diagnosis Cure rates were high and consistent with previously reported cure rates Conclusion: MTT varies across HCV patient groups, from over 6 months to 1 day This analysis shows that a quick treatment start is possible, both in general population and in vulnerable populations, supporting the feasibility of a TnT approach in all populations New strategies should be considered to engage patients with mental disorders in this model of care more effectively.