Recommended Citation
Capelli GP, Wankowski D, Adefisoye J, et al. COVID-19 Positivity as a Potential Risk Factor for Autoimmune Liver Disease. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Coronavirus disease 2019 (COVID-19) remains a relatively new condition, with its complications still under investigation. Previous studies have identified SARS-CoV-2 as a possible trigger for autoimmunity through immune system hyperstimulation and molecular mimicry. Therefore, one potential complication of COVID-19 is the development of autoimmune diseases, including autoimmune liver diseases (AILD) such as primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and IgG4-related hepatobiliary disease (IgG4-HD). Identifying COVID-19 as a risk factor for AILD could hold significant clinical implications, particularly if the incidence of these conditions increases in the wake of the pandemic.
Purpose:
This study aims to determine whether prior COVID-19 positivity is associated with new diagnoses of AILD.
Methods:
A retrospective case-control study was conducted using the electronic medical records of Advocate Health Care and Aurora Health Care. Patients with ICD-10 codes for PSC, PBC, AIH, and IgG4-HD who sought care between January 2020 and January 2023 were identified. Manual chart review confirmed diagnoses based on clinical, serologic, and/or histologic findings and verified COVID-19 testing status by PCR in a healthcare setting. Cases were matched 1:1 to controls by age, sex, and race, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association.
Results:
Of 2,739 patients identified, 434 met inclusion criteria after manual review (188 PBC, 61 PSC, 162 AIH, 8 IgG4-HD, 13 PBC-AIH overlap, 2 PSC-AIH overlap). The OR for any AILD diagnosis following a positive COVID-19 test was 1.94 (95% CI 1.17–3.22, p=0.01). ORs for PSC, AIH, and PBC were 1.85 (95% CI 0.51–6.67, p=0.34), 1.99 (95% CI 0.86–4.61, p=0.10), and 1.70 (95% CI 0.78–3.71, p=0.18), respectively. Due to small sample sizes, ORs for overlap syndromes and IgG4-HD were not calculated.
Conclusion:
This study observed a statistically significant association between prior COVID-19 positivity and a diagnosis of an AILD. However, individual conditions did not achieve significance, possibly due to limited sample sizes. Because these findings suggest a possible association between COVID-19 positivity and a diagnosis of an AILD, further investigation of this potential relationship is warranted.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Poster
COVID-19 Positivity as a Potential Risk Factor for Autoimmune Liver Disease
Background/Significance:
Coronavirus disease 2019 (COVID-19) remains a relatively new condition, with its complications still under investigation. Previous studies have identified SARS-CoV-2 as a possible trigger for autoimmunity through immune system hyperstimulation and molecular mimicry. Therefore, one potential complication of COVID-19 is the development of autoimmune diseases, including autoimmune liver diseases (AILD) such as primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and IgG4-related hepatobiliary disease (IgG4-HD). Identifying COVID-19 as a risk factor for AILD could hold significant clinical implications, particularly if the incidence of these conditions increases in the wake of the pandemic.
Purpose:
This study aims to determine whether prior COVID-19 positivity is associated with new diagnoses of AILD.
Methods:
A retrospective case-control study was conducted using the electronic medical records of Advocate Health Care and Aurora Health Care. Patients with ICD-10 codes for PSC, PBC, AIH, and IgG4-HD who sought care between January 2020 and January 2023 were identified. Manual chart review confirmed diagnoses based on clinical, serologic, and/or histologic findings and verified COVID-19 testing status by PCR in a healthcare setting. Cases were matched 1:1 to controls by age, sex, and race, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association.
Results:
Of 2,739 patients identified, 434 met inclusion criteria after manual review (188 PBC, 61 PSC, 162 AIH, 8 IgG4-HD, 13 PBC-AIH overlap, 2 PSC-AIH overlap). The OR for any AILD diagnosis following a positive COVID-19 test was 1.94 (95% CI 1.17–3.22, p=0.01). ORs for PSC, AIH, and PBC were 1.85 (95% CI 0.51–6.67, p=0.34), 1.99 (95% CI 0.86–4.61, p=0.10), and 1.70 (95% CI 0.78–3.71, p=0.18), respectively. Due to small sample sizes, ORs for overlap syndromes and IgG4-HD were not calculated.
Conclusion:
This study observed a statistically significant association between prior COVID-19 positivity and a diagnosis of an AILD. However, individual conditions did not achieve significance, possibly due to limited sample sizes. Because these findings suggest a possible association between COVID-19 positivity and a diagnosis of an AILD, further investigation of this potential relationship is warranted.
Affiliations
Aurora St. Luke's Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center