Liver injury after SARS-CoV-2 vaccination : Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
© 2022 American Association for the Study of Liver Diseases..
BACKGROUND AND AIMS: A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series.
APPROACH AND RESULTS: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up.
CONCLUSIONS: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2022 |
---|---|
Erschienen: |
2022 |
Enthalten in: |
Zur Gesamtaufnahme - volume:76 |
---|---|
Enthalten in: |
Hepatology (Baltimore, Md.) - 76(2022), 6 vom: 29. Dez., Seite 1576-1586 |
Sprache: |
Englisch |
---|
Links: |
---|
Themen: |
B5S3K2V0G8 |
---|
Anmerkungen: |
Date Completed 15.11.2022 Date Revised 09.03.2023 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1002/hep.32572 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM340904542 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM340904542 | ||
003 | DE-627 | ||
005 | 20231226010534.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231226s2022 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1002/hep.32572 |2 doi | |
028 | 5 | 2 | |a pubmed24n1136.xml |
035 | |a (DE-627)NLM340904542 | ||
035 | |a (NLM)35567545 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Efe, Cumali |e verfasserin |4 aut | |
245 | 1 | 0 | |a Liver injury after SARS-CoV-2 vaccination |b Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome |
264 | 1 | |c 2022 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 15.11.2022 | ||
500 | |a Date Revised 09.03.2023 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a © 2022 American Association for the Study of Liver Diseases. | ||
520 | |a BACKGROUND AND AIMS: A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series | ||
520 | |a APPROACH AND RESULTS: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up | ||
520 | |a CONCLUSIONS: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 7 | |a COVID-19 Vaccines |2 NLM | |
650 | 7 | |a ChAdOx1 nCoV-19 |2 NLM | |
650 | 7 | |a B5S3K2V0G8 |2 NLM | |
650 | 7 | |a BNT162 Vaccine |2 NLM | |
700 | 1 | |a Kulkarni, Anand V |e verfasserin |4 aut | |
700 | 1 | |a Terziroli Beretta-Piccoli, Benedetta |e verfasserin |4 aut | |
700 | 1 | |a Magro, Bianca |e verfasserin |4 aut | |
700 | 1 | |a Stättermayer, Albert |e verfasserin |4 aut | |
700 | 1 | |a Cengiz, Mustafa |e verfasserin |4 aut | |
700 | 1 | |a Clayton-Chubb, Daniel |e verfasserin |4 aut | |
700 | 1 | |a Lammert, Craig |e verfasserin |4 aut | |
700 | 1 | |a Bernsmeier, Christine |e verfasserin |4 aut | |
700 | 1 | |a Gül, Özlem |e verfasserin |4 aut | |
700 | 1 | |a la Tijera, Fatima Higuera-de |e verfasserin |4 aut | |
700 | 1 | |a Anders, Margarita |e verfasserin |4 aut | |
700 | 1 | |a Lytvyak, Ellina |e verfasserin |4 aut | |
700 | 1 | |a Akın, Mete |e verfasserin |4 aut | |
700 | 1 | |a Purnak, Tugrul |e verfasserin |4 aut | |
700 | 1 | |a Liberal, Rodrigo |e verfasserin |4 aut | |
700 | 1 | |a Peralta, Mirta |e verfasserin |4 aut | |
700 | 1 | |a Ebik, Berat |e verfasserin |4 aut | |
700 | 1 | |a Duman, Serkan |e verfasserin |4 aut | |
700 | 1 | |a Demir, Nurhan |e verfasserin |4 aut | |
700 | 1 | |a Balaban, Yasemin |e verfasserin |4 aut | |
700 | 1 | |a Urzua, Álvaro |e verfasserin |4 aut | |
700 | 1 | |a Contreras, Fernando |e verfasserin |4 aut | |
700 | 1 | |a Venturelli, Maria Grazia |e verfasserin |4 aut | |
700 | 1 | |a Bilgiç, Yılmaz |e verfasserin |4 aut | |
700 | 1 | |a Medina, Adriana |e verfasserin |4 aut | |
700 | 1 | |a Girala, Marcos |e verfasserin |4 aut | |
700 | 1 | |a Günşar, Fulya |e verfasserin |4 aut | |
700 | 1 | |a Londoño, Maria-Carlota |e verfasserin |4 aut | |
700 | 1 | |a Androutsakos, Theodoros |e verfasserin |4 aut | |
700 | 1 | |a Kisch, Ayelen |e verfasserin |4 aut | |
700 | 1 | |a Yurci, Alper |e verfasserin |4 aut | |
700 | 1 | |a Güzelbulut, Fatih |e verfasserin |4 aut | |
700 | 1 | |a Çağın, Yasir Furkan |e verfasserin |4 aut | |
700 | 1 | |a Avcı, Enver |e verfasserin |4 aut | |
700 | 1 | |a Akyıldız, Murat |e verfasserin |4 aut | |
700 | 1 | |a Dindar-Demiray, Emine Kübra |e verfasserin |4 aut | |
700 | 1 | |a Harputluoğlu, Murat |e verfasserin |4 aut | |
700 | 1 | |a Kumar, Rahul |e verfasserin |4 aut | |
700 | 1 | |a Satapathy, Sanjaya K |e verfasserin |4 aut | |
700 | 1 | |a Mendizabal, Manuel |e verfasserin |4 aut | |
700 | 1 | |a Silva, Marcelo |e verfasserin |4 aut | |
700 | 1 | |a Fagiuoli, Stefano |e verfasserin |4 aut | |
700 | 1 | |a Roberts, Stuart K |e verfasserin |4 aut | |
700 | 1 | |a Soylu, Neşe Karadağ |e verfasserin |4 aut | |
700 | 1 | |a Idilman, Ramazan |e verfasserin |4 aut | |
700 | 1 | |a Yoshida, Eric M |e verfasserin |4 aut | |
700 | 1 | |a Montano-Loza, Aldo J |e verfasserin |4 aut | |
700 | 1 | |a Dalekos, George N |e verfasserin |4 aut | |
700 | 1 | |a Ridruejo, Ezequiel |e verfasserin |4 aut | |
700 | 1 | |a Schiano, Thomas D |e verfasserin |4 aut | |
700 | 1 | |a Wahlin, Staffan |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Hepatology (Baltimore, Md.) |d 1983 |g 76(2022), 6 vom: 29. Dez., Seite 1576-1586 |w (DE-627)NLM012603902 |x 1527-3350 |7 nnns |
773 | 1 | 8 | |g volume:76 |g year:2022 |g number:6 |g day:29 |g month:12 |g pages:1576-1586 |
856 | 4 | 0 | |u http://dx.doi.org/10.1002/hep.32572 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 76 |j 2022 |e 6 |b 29 |c 12 |h 1576-1586 |