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1. Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

Author

Marasco, G., Cremon, C., Barbaro, M. R., Salvi, D., Cacciari, G., Kagramanova, A., Bordin, D., Drug, V., Miftode, E., Fusaroli, P., Mohamed, S. Y., Ricci, C., Bellini, M., Rahman, M. M., Melcarne, L., Santos, J., Lobo, B., Bor, S., Yapali, S., Akyol, D., Sapmaz, F. P., Urun, Y. Y., Eskazan, T., Celebi, A., Kacmaz, H., Ebik, B., Binicier, H. C., Bugdayci, M. S., Yagci, M. B., Pullukcu, H., Kaya, B. Y., Tureyen, A., Hatemi, I., Koc, E. S., Sirin, G., Caliskan, A. R., Bengi, G., Alis, E. E., Lukic, S., Trajkovska, M., Hod, K., Dumitrascu, D., Pietrangelo, A., Corradini, E., Simren, M., Sjolund, J., Tornkvist, N., Ghoshal, U. C., Kolokolnikova, O., Colecchia, A., Serra, J., Maconi, G., De Giorgio, R., Danese, S., Portincasa, P., Di Stefano, M., Maggio, M., Philippou, E., Lee, Y. Y., Venturi, A., Borghi, C., Zoli, M., Gionchetti, P., Viale, P., Stanghellini, V., Barbara, G., Piacentini, A., Shengelia, M., Vechorko, V., Cardamone, C., Rosei, C. A., Pancetti, A., Rettura, F., Pedrosa, M., Campoli, C., Mijac, D., Korac, M., Karic, U., Markovic, A., Najdeski, A., Nikolova, D., Dimzova, M., Lior, O., Shinhar, N., Perelmutter, O., Ringel, Y., Sabo, C. M., Chis, A., Bonucchi, G., Caio, G. P. I., Ghirardi, C., Marziani, B., Rizzello, B., Aguilar, A., Capogreco, A., Aghemo, A., Di Paolo, D. M., Marconi, G., Di Sabatino, A., Tagliaferri, S., Naves, J. E., Galli, A., Dragoni, G., Nedelcu, L., Mauloni, P. A., Del Vecchio, S., Rotondo, L., Capuani, F., Montanari, D., Palombo, F., Paone, C., Mastel, G., Fontana, C., Bellacosa, L., Cogliandro, R. F., Marasco, Giovanni, Cremon, Cesare, Barbaro, Maria Raffaella, Salvi, Daniele, Cacciari, Giulia, Kagramanova, Anna, Bordin, Dmitry, Drug, Vasile, Miftode, Edgidia, Fusaroli, Pietro, Mohamed, Salem Youssef, Ricci, Chiara, Bellini, Massimo, Rahman, M Masudur, Melcarne, Luigi, Santos, Javier, Lobo, Beatriz, Bor, Serhat, Yapali, Suna, Akyol, Deniz, Sapmaz, Ferdane Pirincci, Urun, Yonca Yilmaz, Eskazan, Tugce, Celebi, Altay, Kacmaz, Huseyin, Ebik, Berat, Binicier, Hatice Cilem, Bugdayci, Mehmet Sait, Yağcı, Munkhtsetseg Banzragch, Pullukcu, Husnu, Kaya, Berrin Yalınba, Tureyen, Ali, Hatemi, İbrahim, Koc, Elif Sitre, Sirin, Goktug, Calıskan, Ali Riza, Bengi, Goksel, Alıs, Esra Ergun, Lukic, Snezana, Trajkovska, Meri, Hod, Keren, Dumitrascu, Dan, Pietrangelo, Antonello, Corradini, Elena, Simren, Magnu, Sjolund, Jessica, Tornkvist, Navkiran, Ghoshal, Uday C, Kolokolnikova, Olga, Colecchia, Antonio, Serra, Jordi, Maconi, Giovanni, De Giorgio, Roberto, Danese, Silvio, Portincasa, Pietro, Di Stefano, Michele, Maggio, Marcello, Philippou, Elena, Lee, Yeong Yeh, Venturi, Alessandro, Borghi, Claudio, Zoli, Marco, Gionchetti, Paolo, Viale, Pierluigi, Stanghellini, Vincenzo, and Barbara, Giovanni

Subjects
Male, medicine.medical_specialty, Settore MED/17 - Malattie Infettive, Coronavirus disease 2019 (COVID-19), Nausea, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), diarrhea, Disease, Gastrointestinal Symptoms, COVID-19, Acute Respiratory Syndrome, GI-COVID-19, NO, Russia, Manifestations, Interviews as Topic, Rating scale, Internal medicine, Surveys and Questionnaires, parasitic diseases, medicine, Prevalence, Humans, In patient, Prospective Studies, Respiratory system, Settore MED/12 - Gastroenterologia, Hepatology, business.industry, SARS-CoV-2, pandemic, Gastroenterology, COVID-19, Middle Aged, gastrointestinal, Gastroenteritis, Europe, Hospital admission, Egypt, Female, medicine.symptom, business, human activities
Abstract

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection., Fondazione Cassa di Risparmio in Bologna; Italian Ministry of Education, University and Research; Fondazione del Monte di Bologna e Ravenna [SC1-BHC-01-2019]; European Grant H2020, DISCOvERIE [SC1-BHC-01-2019]; Italian Ministry of Health [Ricerca Finalizzata GR-2018-12367062], G.B. contribution to this research was permitted in part by funding from Fondazione Cassa di Risparmio in Bologna; the ItalianMinistry of Education, University and Research; and Fondazione del Monte di Bologna e Ravenna and European Grant H2020, DISCOvERIE, SC1-BHC-01-2019. M.R.B. is a recipient of a grant from the Italian Ministry of Health (Ricerca Finalizzata GR-2018-12367062). None of the funding organizations have had any role in the design and conduct of the study; in the collection, management, and analysis of the data; or in the preparation, review, and approval of the article.

Published
2022

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

Author

George N. Dalekos, Cristina Rigamonti, Godolfino Miranda Zazueta, Ali Rıza Calışkan, Annarosa Floreani, Berat Ebik, Kadri Atay, Aylin Demirezer Bolat, Nazım Ekin, Eric M. Yoshida, Graciela Castro Narro, Fatih Güzelbulut, Murat Biyik, Manuel Mendizabal, Renumathy Dhanasekaran, Stefano Fagiuoli, Thomas D. Schiano, Ellina Lytvyak, Shalom Frager, Nataly Chris Escajadillo Vargas, Yucel Ustundag, Ramazan Idilman, Andreea M. Catana, Alvaro Urzúa, Ahmet Yavuz, Staffan Wahlin, Mesut Aydin, Cumali Efe, Laura Cristoferi, Hatef Massoumi, Maria Vincent, Sandro Ruiz Garcia, Evrim Kahramanoğlu-Aksoy, Natalia Ratusnu, Craig Lammert, Sümeyra Yıldırım, Mário Reis Álvares-da-Silva, Murat Harputoğlu, Marina Silveira, Murat Kiyici, Fátima Higuera-de la Tijera, Nurhan Demir, Cynthia Levy, Einar Bjornsson, Javier Brahm, Rotonya M. Carr, Nidah S. Khakoo, Andres Jose Gomez Aldana, Murat Akyildiz, Leyla Nazal, Alessio Gerussi, Tuğçe Eşkazan, Zeynep Ellik, Pietro Invernizzi, Fulya Gunsar, Ezequiel Ridruejo, Eleonora De Martin, Tugrul Purnak, Fatih Eren, Hüseyin Kaçmaz, Margarita Anders, Nikolaos K. Gatselis, Romee Snijders, Sezgin Barutçu, Costica Aloman, Alexandra Heurgue-Berlot, Bianca Magro, Jonathan Aguirre, Kader Irak, Koray Tascilar, Aldo J. Montano-Loza, Marcelo Silva, David N. Assis, Joost P.H. Drenth, Eira Cerda Reyes, Ibrahim Hatemi, Mirta Peralta, Sanjaya K. Satapathy, James L. Boyer, Yasemin H. Balaban, Efe, C, Lammert, C, Tascilar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Purnak, T, Rigamonti, C, Aldana, A, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoglu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, M, Cristoferi, L, Urzua, A, Eskazan, T, Magro, B, Snijders, R, Barutcu, S, Lytvyak, E, Zazueta, G, Demirezer-Bolat, A, Aydin, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yildirim, S, Yavuz, A, Biyik, M, Narro, G, Kiyici, M, Akyildiz, M, Kahramanoglu-Aksoy, E, Vincent, M, Carr, R, Gunsar, F, Reyes, E, Harputluoglu, M, Aloman, C, Gatselis, N, Ustundag, Y, Brahm, J, Vargas, N, Guzelbulut, F, Garcia, S, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, S, Silveira, M, Drenth, J, Dalekos, G, Assis, D, Bjornsson, E, Boyer, J, Yoshida, E, Invernizzi, P, Levy, C, Montano-Loza, A, Schiano, T, Ridruejo, E, Wahlin, S, Akyıldız, Murat (ORCID 0000-0002-2080-7528 & YÖK ID 123080), Efe, Cumalı, Lammert, Craig, Taşçılar, Koray, Dhanasekaran, Renumathy, Ebik, Berat, Higuera-de la Tijera, Fatima, Çalışkan, Ali R., Peralta, Mirta, Gerussi, Alessio, Massoumi, Hatef, Catana, Andreea M., Purnak, Tuğrul, Rigamonti, Cristina, Aldana, Andres J. G., Khakoo, Nidah, Nazal, Leyla, Frager, Shalom, Demir, Nurhan, Irak, Kader, Melekoğlu-Ellik, Zeynep, Kaçmaz, Hüseyin, Balaban, Yasemin, Atay, Kadri, Eren, Fatih, Alvares-da-Silva, Mario R., Cristoferi, Laura, Urzua, Alvaro, Eskazan, Tugce, Magro, Bianca, Snijders, Romee, Barutçu, Sezgin, Lytvyak, Ellina, Zazueta, Godolfino M., Demirezer-Bolat, Aylin, Aydın, Mesut, Heurgue-Berlot, Alexandra, De Martin, Eleonora, Ekin, Nazım, Yıldırım, Sumeyra, Yavuz, Ahmet, Bıyık, Murat, Narro, Graciela C., Kıyıcı, Murat, Kahramanoğlu-Aksoy, Evrim, Vincent, Maria, Carr, Rotonya M., Günsar, Fulya, Reyes, Eira C., Harputluoğlu, Murat, Aloman, Costica, Gatselis, Nikolaos K., Üstündağ, Yücel, Brahm, Javier, Vargas, Nataly C. E., Güzelbulut, Fatih, Garcia, Sandro R., Aguirre, Jonathan, Anders, Margarita, Ratusnu, Natalia, Hatemi, İbrahim, Mendizabal, Manuel, Floreani, Annarosa, Fagiuoli, Stefano, Silva, Marcelo, İdilman, Ramazan, Satapathy, Sanjaya K., Silveira, Marina, Drenth, Joost P. H., Dalekos, George N., Assis, David N., Bjornsson, Einar, Boyer, James L., Yoshida, Eric M., Invernizzi, Pietro, Levy, Cynthia, Montano-Loza, Aldo J., Schiano, Thomas D., Ridruejo, Ezequiel, Wahlin, Staffan, and School of Medicine

Subjects
Adult, Male, medicine.medical_specialty, budesonide, Cirrhosis, Adolescent, Gastroenterology and hepatology, medicine.medical_treatment, Azathioprine, Autoimmune hepatitis, mercaptopurine, Liver transplantation, Gastroenterology, Young Adult, Sars-Cov-2 Infection, Internal medicine, medicine, Humans, Autoimmunity, Budesonide, Mercaptopurine, SARS-CoV-2, Aged, Retrospective Studies, Mechanical ventilation, Aged, 80 and over, azathioprine, liver transplantation, Hepatology, business.industry, autoimmunity, COVID-19, Immunosuppression, Odds ratio, Middle Aged, medicine.disease, Tacrolimus, Liver-Transplant Recipients, Hospitalization, Hepatitis, Autoimmune, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Pharmaceutical Preparations, Female, business, medicine.drug
Abstract

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., Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic), A. Gerussi, L. Cristoferi, and P. Invernizzi acknowledge that this research was partially supported by the Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic).

Published
2021

3. Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

Author

Fátima Higuera-de la Tijera, Renumathy Dhanasekaran, Mirta Peralta, C. Levy, Laura Cristoferi, Hüseyin Kaçmaz, Romee Snijders, David N. Assis, Cristina Rigamonti, Ali Rıza Calışkan, Nidah S. Khakoo, Alessio Gerussi, Alvaro Urzúa, Ezequiel Ridruejo, Yasemin H. Balaban, Craig Lammert, Ersin Batıbay, Kader Irak, Thomas D. Schiano, Marina Silveira, Fatih Eren, Berat Ebik, Kadri Atay, Andreea M. Catana, Cumali Efe, Staffan Wahlin, Murat Harputluoglu, Ibrahim Hatemi, Einar Bjornsson, Nurhan Demir, Murat Akyildiz, Manuel Mendizabal, Murat Kiyici, Costica Aloman, Rotonya M. Carr, Nazım Ekin, Ramazan Idilman, Marcelo Silva, Andres Jose Gomez Aldana, James L. Boyer, Murat Torgutalp, Tugrul Purnak, Zeynep Ellik, Leyla Nazal, Shalom Frager, Joost P.H. Drenth, Hatef Massoumi, Pietro Invernizzi, Efe, C, Dhanasekaran, R, Lammert, C, Ebik, B, Higuera-de la Tijera, F, Aloman, C, Riza Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Torgutalp, M, Purnak, T, Rigamonti, C, Gomez Aldana, A, Khakoo, N, Kacmaz, H, Nazal, L, Frager, S, Demir, N, Irak, K, Ellik, Z, Balaban, Y, Atay, K, Eren, F, Cristoferi, L, Batibay, E, Urzua, A, Snijders, R, Kiyici, M, Akyildiz, M, Ekin, N, Carr, R, Harputluoglu, M, Hatemi, I, Mendizabal, M, Silva, M, Idilman, R, Silveira, M, Drenth, J, Assis, D, Bjornsson, E, Boyer, J, Invernizzi, P, Levy, C, Schiano, T, Ridruejo, E, Wahlin, S, Akyıldız, Murat, Efe, C., Dhanasekaran, R., Lammert, C., Ebi, B., Higuera-de la Tijera, F., Aloman, C., Çalışkan, A. R., Peralta, M., Gerussi, A., Massoumi, H., Catana, A. M., Torgutalp, M., Pürnak T., Rigamonti, C., Aldana, A. J. G., Khakoo, N., Kaçmaz, H., Nazal, L., Frager, S., Demir, N., Irak, K., Ellik, Z. M., Balaban, Y., Atay, K., Eren, F., Cristoferi, L., Batıbay, E., Urzua, Á., Snijders, R., Kıyıcı, M., Ekin, N., Carr, R. M., Harputoğlu, M., Hatemi, İ., Mendizabal, M., Silva, M., İdilman, R., Silveira, M., Drenth, J. P. H., Assis, D. N., Björnsson, E., Boyer, J. L., Invernizzi, P., Levy, C., Schiano, T. D., Ridruejo, E., Wahlin, S., and School of Medicine

Subjects
Adult, Male, medicine.medical_specialty, Cirrhosis, Adolescent, medicine.medical_treatment, America, Autoimmune hepatitis, Liver transplantation, liver, Gastroenterology, Young Adult, AIH, Retrospective Studie, Internal medicine, purl.org/becyt/ford/3.2 [https], medicine, Humans, Propensity Score, Determinants, Retrospective Studies, Aged, Hepatitis, Liver injury, Aged, 80 and over, Hepatology, business.industry, COVID-19, Immunosuppression, Retrospective cohort study, Middle Aged, medicine.disease, Autoimmunity, Liver failure, Mycophenolate mofetil, Steroids, Tacrolimus, Europe, Hepatitis, Autoimmune, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Cohort, Female, purl.org/becyt/ford/3 [https], Americas, Erratum, business, Rapid Communication, Human
Abstract

Background: data regarding outcome of Coronavirus disease 2019 (COVID-19) in patients with autoimmune hepatitis (AIH) are lacking. Patients and methods: we performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated. Results: we included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe COVID-19 (15.5% vs 20.2% p=0.231) and all-cause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p, Italian Ministry of University; Research (MIUR)-Department of Excellence Project PREMIA; AMAF Monza ONLUS; AIRCS

Published
2021

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