Protective effect of ursodeoxycholic acid on COVID-19 in patients with chronic liver disease
Yanyan Li, Na Zhu, Xinyu Cui, Yingying Lin, Xin Li
Frontiers in Cellular and Infection Microbiology, doi:10.3389/fcimb.2023.1178590
Objective: Ursodeoxycholic acid (UDCA) may reduce susceptibility to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by downregulating angiotensin-converting enzyme 2 (ACE2), based on recent experimental investigation. This study aimed to determine the potential protective effect of UDCA against SARS-CoV-2 infection in patients with chronic liver disease. Methods: Patients with chronic liver disease receiving UDCA (taking UDCA ≥1 month) at Beijing Ditan Hospital between January 2022 and December 2022 were consecutively enrolled. These patients were matched in a 1:1 ratio to those with liver disease not receiving UDCA during the same period by using a propensity score matching analysis with nearest neighbor matching algorithm. We conducted a phone survey of coronavirus disease 2019 (COVID-19) infection during the early phase of the pandemic liberation (from 15 December 2022 to 15 January 2023). The risk of COVID-19 was compared in two matched cohorts of 225 UDCA users and 225 non-UDCA users based on patient self-report. Results: In the adjusted analysis, the control group was superior to the UDCA group in COVID-19 vaccination rates and liver function indicators, including gglutamyl transpeptidase and alkaline phosphatase (p < 0.05). UDCA was associated with a lower incidence of SARS-CoV-2 infection (UDCA 85.3% vs. control 94.2%, p = 0.002), more mild cases (80.0% vs. 72.0%, p = 0.047), and shorter median time from infection to recovery (5 vs. 7 days, p < 0.001). Logistic regression analysis showed that UDCA was a significant protective factor against COVID-19 infection (OR: 0.32, 95%CI: 0.16-0.64, p = 0.001). Furthermore, diabetes mellitus (OR: 2.48, 95%CI: 1.11-5.54, p = 0.027) and moderate/severe infection (OR: 8.94, 95%CI: 1.07-74.61, p = 0.043) were more likely to prolong the time from infection to recovery.
Ethics statement The studies involving human participants were reviewed and approved by The Ethical Review Committee of the Beijing Ditan Hospital. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions YLi was the first author of this study. Study design: YLi. Data collection: NZ. Analysis of data: YLin and XC. Drafting of the manuscript: YLi. Critical reversion of the manuscript: XL. Material and technical support, and study supervision: XL. All authors have read and approved the manuscript.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/ fcimb.2023.1178590/full#supplementary-material SUPPLEMENTARY FIGURE 1 Influence..
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'abstract': '<jats:sec><jats:title>Objective</jats:title><jats:p>Ursodeoxycholic acid (UDCA) may reduce '
'susceptibility to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by '
'downregulating angiotensin-converting enzyme 2 (ACE2), based on recent experimental '
'investigation. This study aimed to determine the potential protective effect of UDCA against '
'SARS-CoV-2 infection in patients with chronic liver '
'disease.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients with '
'chronic liver disease receiving UDCA (taking UDCA ≥1 month) at Beijing Ditan Hospital between '
'January 2022 and December 2022 were consecutively enrolled. These patients were matched in a '
'1:1 ratio to those with liver disease not receiving UDCA during the same period by using a '
'propensity score matching analysis with nearest neighbor matching algorithm. We conducted a '
'phone survey of coronavirus disease 2019 (COVID-19) infection during the early phase of the '
'pandemic liberation (from 15 December 2022 to 15 January 2023). The risk of COVID-19 was '
'compared in two matched cohorts of 225 UDCA users and 225 non-UDCA users based on patient '
'self-report.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the '
'adjusted analysis, the control group was superior to the UDCA group in COVID-19 vaccination '
'rates and liver function indicators, including γ-glutamyl transpeptidase and alkaline '
'phosphatase (p &lt; 0.05). UDCA was associated with a lower incidence of SARS-CoV-2 '
'infection (UDCA 85.3% <jats:italic>vs.</jats:italic> control 94.2%, p = 0.002), more mild '
'cases (80.0% <jats:italic>vs.</jats:italic> 72.0%, p = 0.047), and shorter median time from '
'infection to recovery (5 <jats:italic>vs.</jats:italic> 7 days, p &lt; 0.001). Logistic '
'regression analysis showed that UDCA was a significant protective factor against COVID-19 '
'infection (OR: 0.32, 95%CI: 0.16–0.64, p = 0.001). Furthermore, diabetes mellitus (OR: 2.48, '
'95%CI: 1.11–5.54, p = 0.027) and moderate/severe infection (OR: 8.94, 95%CI: 1.07–74.61, p = '
'0.043) were more likely to prolong the time from infection to '
'recovery.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>UDCA '
'therapy may be beneficial in reducing COVID-19 infection risk, alleviating symptoms, and '
'shortening the recovery time in patients with chronic liver disease. However, it should be '
'emphasized that the conclusions were based on patient self-report rather than classical '
'COVID-19 detection by experimental investigations. Further large clinical and experimental '
'studies are needed to validate these findings.</jats:p></jats:sec>',
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