key: cord-0698283-ofzi4ls1
authors: Rigamonti, Cristina; Cittone, Micol Giulia; De Benedittis, Carla; Rizzi, Eleonora; Casciaro, Giuseppe Francesco; Bellan, Mattia; Sainaghi, Pier Paolo; Pirisi, Mario
title: Rates of symptomatic SARS-CoV-2 infection in patients with autoimmune liver diseases in Northern Italy: a telemedicine study
date: 2020-05-30
journal: Clin Gastroenterol Hepatol
DOI: 10.1016/j.cgh.2020.05.047
sha: 03b8b410de02669897d10535f2093301a164e836
doc_id: 698283
cord_uid: ofzi4ls1

nan

Financial support: this study had no financial support.

C.R. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: C.R., M.P.

Acquisition of data: C.R., MG. C, E.R., C.D., GF. C., M. B.

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is a virus responsible for a variety of clinical manifestations that, besides the lungs, can involve several other organs, leading to both mild and severe complications. 1, 2, 3 There is scarce information regarding the interaction between pre-existing liver disease and SARS-CoV-2 infection; specifically, there is no demonstration that patients with autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are at higher risk of Coronavirus disease 2019 (COVID-19). One major difficulty in addressing these issues has been the limited access to outpatient clinics due to pandemic, with deferral of all routine follow-up visits.

Here, we report our experience on telemedicine conducted by hepatologists in a Tertiary-care Center for Liver Disease of a University Hospital in Northern Italy along a two weeks period during the COVID-19 pandemic.

From 1 st to 17 th April 2020, all patients with previous diagnosis of AIH or PBC who were under follow-up at our Tertiary-care Center for Liver Disease at University Hospital in Novara (in eastern Piedmont, close to Lombardy) were consecutively included in this study. They underwent a telephone survey in order to state whether they had experienced symptoms related to SARS-CoV-2 infection, had been cured at home or had been hospitalized for COVID-19 during epidemic emergency.

Out of 141 patients (73 AIH, 68 PBC), all except 3 (2 AIH, 1 PBC) answered the telephone survey described above. Demographic and clinical features of included patients are shown in supplementary Table 1 .

All but one AIH patients were in biochemical remission with immunosuppressive regimen (prednisone with/without azathioprine).

All PBC patients were on ursodeoxycholic acid treatment, five with obeticholic acid. Table 1 .

Two AIH patients (one cirrhotic male who had an acute onset of AIH and was under high-dose steroids, as per induction protocol, and a female in biochemical remission under prednisone) developed respiratory failure due to COVID-19 pneumonia with need of hospitalization. They received combination treatment with lopinavir/ritonavir and hydroxychloroquine and fully recovered ( Table 1) ; during hospitalization liver enzymes were monitored (supplementary Table 2 ).

Three additional patients (2 AIH and 1 PBC) developed fever and cough without respiratory failure and were managed at home under mandatory quarantine, treated with hydroxychloroquine ( Table 1 ) with full recovery. All of them referred intense fatigue, anosmia, one had also diarrhea.

Up to now, the real impact of COVID-19 in patients with autoimmune liver diseases has not been described so far 4 . This pandemic has outlined the need to face a deep change in hospital organization in order to prevent a further spread of infection. Overall incidence in our cohort resulted about 7 and 5 times higher than those estimated in Piedmont and Lombardy (by 21 st April was about 0.50 and 0.67%, respectively) 6, 7 . However, these findings need to be interpreted with caution since it is likely that true infection rates in the general population are grossly underestimated.

Moreover, half of the patients presented were older than 63 years, only 25% of them being younger than 50 years. Nevertheless, they were also unbalanced with regard to gender, with a large predominance of women. Thus, the extent to which they can be compared to the reference general population is limited. Rates of COVID-19 was 5.6% among patients with AIH (11 and 8 times higher compared to official estimates in Piedmont and Lombardy, respectively) and 1.5% among PBC patients. AIH patients suffered of COVID-19 more frequently than PBC patients, maybe due to immunosuppressive treatment. Our data on incidence seemed a little bit higher than the preliminary data reported by D'Antiga 8 .

Outcome of our patients affected by COVID-19 was anyway favorable. In fact, this is the first study, which attempted to assess outbreak and outcome of SARS-CoV-2 infection in all consecutive patients with AIH or PBC followed-up in a single Center.

In conclusion, our study emphasized the usefulness of telemedicine for maintaining the continuity of care among patients with autoimmune liver diseases during the pandemic. Finally, It showed quite low rates of symptomatic SARS-CoV-2 infection with overall favorable outcome among AIH and PBC patients. 

Clinical characteristics of coronavirus disease 2019 in China

Coronavirus Disease 2019 (COVID-19) in Italy

Highlights for management of patients with Autoimmune Liver Disease during COVID-19 pandemia

Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper

Official site of "Ministero della Salute

Coronaviruses and Immunosuppressed Patients: The Facts During the Third Epidemic