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.
ABSTRACT
Background: In December 2019, a new contagious disease, named COVID-19 and caused by a novel coronavirus (SARSCov- 2), emerged in Wuhan City, China, and is now spreading across international borders Although the disease mainly causes respiratory symptoms, it can also cause impairmentof other organs Interestingly, in many cohorts of patients infected with SARS-Cov-2 it has been noted a more or less significant increase of transaminases, however the real impact of such alteration on liver function is currently unknown This study aimed at evaluating the impact of COVID-19 on the liver function and the clinical outcome of these patients Methods: In this monocentric retrospective study, patients admitted at the ASST-Papa Giovanni XXIII-Bergamo with diagnosis of COVID-19 between 1stMarch and 30thApril 2020 were enrolled A significant increase of hepatic cytolysis was defined as ALT ≥5xULN. Impairment of liver function was defined as association of ALT ≥5xULN with bilirubin ≥1.5 mg/dL and/or INR ≥ 1.7. Results: One thousand two hundred sixty three patients with confirmed SARS-Cov-2 infection were enrolled (mean age 66 years, 76% males). A significant increase of ALT was present in 47 (4%) of patients and among these 8 (17%) and 3 (6%) presented bilirubin ≥1.5 mg/dL and/or INR ≥ 1 7, respectively Eleven/forty seven patients (23%) died after a median of 5 (1-21) days since COVID-19 diagnosis, with 30-day-mortality rate of 19%, nobody for liver-related causes Age and creatinin were the only independent predictors of mortality. Moreover, mortality rate was no significantly increased in patients with ALT ≥5xULNcompared to patients with ALT <5xULN (p=0 94) Conclusion: Infection for SARSCov- 2 may result in increase of transaminases however it is not associated with significant impairment of liver function and increase of mortality.
ABSTRACT
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.