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Primary biliary cholangitis and SARS-CoV-2 infection: incidence, susceptibility and outcomes
  1. Javier Ampuero1,2,3,4,
  2. Ana Lucena1,
  3. Manuel Hernández-Guerra5,
  4. Isabel Moreno-Moraleda6,
  5. Juan Arenas7,
  6. Isabel Conde8,
  7. Laura Muñoz9,
  8. Lidia Canillas10,
  9. Edgar Fernandez11,
  10. Raisa Quiñones12,
  11. Miguel Angel Simon13,
  12. Elena Gómez-Dominguez14,
  13. Maria Luisa Gutierrez15,
  14. Conrado Fernandez-Rodriguez15,
  15. Maria Jose Domper-Arnal13,
  16. Francisco Jorquera4,12,
  17. Maria Luisa Garcia-Buey11,
  18. Montserrat Garcia-Retortillo10,
  19. Rosa Morillas4,9,
  20. Marina Berenguer4,8,
  21. Marta Casado6,
  22. Dalia Morales-Arraez5,
  23. José Manuel Sousa1,
  24. Esther Molina16
  1. 1 Hepatology Unit, Virgen del Rocio University Hospital, Sevilla, Spain
  2. 2 Instituto de Biomedicina de Sevilla, Sevilla, Spain
  3. 3 Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
  4. 4 (CIBERehd) Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
  5. 5 Gastroenterology and Hepatology, Hospital Universitario de Canarias, La Laguna, Spain
  6. 6 Digestive Department, Complejo Hospitalario Torrecardenas, Almeria, Spain
  7. 7 Digestive Department, Donostia Ospitalea, San Sebastian, Spain
  8. 8 Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
  9. 9 Digestive Department, Hospital Germans Trias i Pujol, Badalona, Spain
  10. 10 Digestive Department, Hospital del Mar, Barcelona, Spain
  11. 11 Digestive Department, Hospital Universitario de la Princesa, Madrid, Spain
  12. 12 Gastroenterology, IBIOMED, Complejo Asistencial Universitario de Leon, Leon, Spain
  13. 13 Digestive Department, Hospital Clinico Zaragoza, Zaragoza, Spain
  14. 14 Servicio de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, Spain
  15. 15 Digestive Diseases Unit, Alcorcón University Hospital, Alcorcon, Spain
  16. 16 Digestive Department, Hospital Clinico Universitario Santiago Compostela, Santiago de Compostela, Spain
  1. Correspondence to Dr Javier Ampuero, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain; javi.ampuero{at}

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We read with interest the work by Mansoor et al 1 regarding the outcomes of COVID-19 in coeliac disease. The impact of pre-existing chronic liver diseases on COVID-19 outcomes has been largely evaluated,2–4 and consequently specific recommendations have been made in these patients.5 However, the relationship between primary biliary cholangitis (PBC) and SARS-CoV-2 remains unknown.6 We aimed to determine (1) the cumulative incidence of SARS-CoV-2 infection in a population of patients with PBC, comparing with the general Spanish cumulative incidence by the end of April 2021; (2) the baseline factors associated with a higher susceptibility to SARS-CoV-2 infection; and (3) the baseline factors associated with COVID-19-related hospitalisation.

We performed a multicentre retrospective study enrolling 1151 patients from 13 Spanish referral hospitals. We collected information about SARS-CoV-2 infection from medical records of all patients with PBC from January 2020 to April 2021 (online supplemental material 1). Exclusion criteria were patients who died before January 2020, liver transplant before or after the enrolment and patients having received some dose of a vaccine against SARS-CoV-2.

Supplemental material


The Spanish government officially publishes the prevalence, incidence and outcomes of SARS-CoV-2 ( For this study, data were accessed on 30 April 2021. The …

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  • Contributors Guarantor of the article: JAm. Study design: JAm. Drafting the manuscript: JAm, CF-R, MB. Statistical analyses and interpretation: JAm. Data acquisition and critical review of the manuscript: all authors. All authors approved the final version of the article, including the authorship list.

  • Funding This project has been partially funded by the 'Consejería de Salud de la Junta de Andalucía' (PI-0075-2014) and the 'Spanish Ministry of Economy, Innovation and Competition, Instituto de Salud Carlos III' (PI19/01404, PI16/01842, PI17/00535 and GLD19/00100).

  • Disclaimer The funders have not had any role in the design, analysis, writing or interpretation of this project.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.