Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis.

BACKGROUND: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). PATIENTS AND METHODS: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. RESULTS: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. CONCLUSION: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.

Gastric Intestinal Metaplasia and Covid 19 Infection

Gastric intestinal metaplasia (GIM) is defined as immigration of enteric or colonic mucosa within gastric lining.Gastric intestinal metaplasia (GIM) is a premalign condition seen in gastric lining. It is prevalent in Asia and may lead to gastric carcinoma at a rate of 1% annually. COVID 19, which has been a global issue since late 2019, causes mostly respiratory symptoms;however, some patients may present with gastrointestinal symptoms including diarrhea, vomiting (5%) and abdominal pain ( 3.8%).We tried in this text to handle any possible association between COVID 19 infection and GIM. In this retrospective study we included 39 COVID 19 patients and 180 age-matched control subjects to compare rate of intestinal metaplasia. All statistical analyses were performed with SAS software (SAS Institute, Cary, N.C.). The clinical and radiological characteristics of patients were compared using Student's t-test. Intestinal metaplasia was found in 11 (28%) of 39 patients while in 7 (3,9%) of 181 controls, which meant a statistical significance (p<0,05). Of the 181 subjects, atrophy was found in 39 (21%) whereas it was noted in 9 (23%) of 39 patients, which yielded no statistical significance (p>0,05). We found that GIM is a premalignant condition that can lead to COVID 19 infection.