Association between ursodeoxycholic acid use and COVID-19 in individuals with chronic liver disease: a nationwide case-control study in South Korea
Sang Yi Moon, Minkook Son, Yeo Wool Kang, Myeongseok Koh, Jong Yoon Lee, Yang Hyun Baek
Virology Journal, doi:10.1186/s12985-024-02464-1
Background Conflicting evidence exists regarding the effects of ursodeoxycholic acid (UDCA) on coronavirus disease 2019 . This study investigates the association between UDCA administration and COVID-19 infection and its related outcomes in individuals with chronic liver disease (CLD). Methods A customized COVID-19 research database (n = 3,485,376) was created by integrating data from the National Health Insurance Service (NHIS) and the Korea Disease Control and Prevention Agency's COVID-19 databases. The study focused on patients diagnosed with COVID-19 in 2021, using the NHIS data from 365 days before diagnosis. To create comparable groups with and without UDCA administration before COVID-19, we used propensity score matching. The primary endpoint was the first confirmed positive result for severe acute respiratory syndrome coronavirus-2. In addition, we identified severe COVID-19-related outcomes. Subgroup analysis were conducted based on the dose of UDCA exposure.
Results Data from 74,074 individuals with CLD was analyzed. The participants' average age was 57.5 years, and 52.1% (19,277) of those in each group were male. Those with prior UDCA exposure had a significantly lower risk of COVID-19 infection (adjusted OR: 0.80, 95% CI [0.76-0.85]) compared to the non-UDCA group. Additionally, the UDCA group had a lower risk of severe ). Subgroup analyses indicated that there was a decrease in COVID-19 infection and its related outcomes with increasing UDCA exposure dose. Conclusions Our large observational study highlights the potential use of readily available UDCA as an adjunctive therapy for COVID-19 in individuals with CLD.
Supplementary Information The online version contains supplementary material available at https://doi. org/10.1186/s12985-024-02464-1.
Supplementary Material 1
Supplementary Material 2
Author contributions Sang Yi Moon and Minkook Son contributed equally to this work as first authors. Dr. S. Moon, M. Son, and Y. Baek had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: S. Moon, M. SonAcquisition, analysis, or interpretation of data: S. Moon, M. Son. Drafting of the manuscript: S. Moon, M. Son. Critical review of the manuscript for important intellectual content: Y, Kang, Y. Baek. Statistical analysis: M. Son. Administrative, technical, or material support: Y. Baek. Supervision: Y. Baek. All authors reviewed the manuscript.
Declarations Ethics approval and consent to participate The Dong-A University College of Medicine Institutional Review Board exempted this retrospective study from review due to its design (utilizing de-identified, publicly available clinical data for analysis) (DAUHIRB-EXP-23-026).
Consent for publication Not applicable.
Additional information This study used the database of the KDCA and the NHIS for policy and academic research. The research number of this study is KDCA-NHIS-2023-1-567. The KDCA is the Korea Disease Control and Prevention Agency, Republic of Korea. The NHIS is the National Health Insurance Service, Republic of Korea.
..
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