{"doi":"10.1111/joim.13630","title":"Ursodeoxycholic acid is associated with a reduction in SARS‐CoV‐2 infection and reduced severity of COVID‐19 in patients with cirrhosis","abstract":"BACKGROUND AND AIMS: Studies have demonstrated that reducing farnesoid X receptor activity with ursodeoxycholic acid (UDCA) downregulates angiotensin-converting enzyme in human lung, intestinal and cholangiocytes organoids in vitro, in human lungs and livers perfused ex situ, reducing internalization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the host cell. This offers a potential novel target against coronavirus disease 2019 (COVID-19). The objective of our study was to compare the association between UDCA exposure and SARS-CoV-2 infection, as well as varying severities of COVID-19, in a large national cohort of participants with cirrhosis. METHODS: In this retrospective cohort study among participants with cirrhosis in the Veterans Outcomes and Costs Associated with Liver cohort, we compared participants with exposure to UDCA, with a propensity score (PS) matched group of participants without UDCA exposure, matched for clinical characteristics, and vaccination status. The outcomes included SARS-CoV-2 infection, symptomatic, at least moderate, severe, or critical COVID-19, and COVID-19-related death. RESULTS: We compared 1607 participants with cirrhosis who were on UDCA, with 1607 PS-matched controls. On multivariable logistic regression, UDCA exposure was associated with reduced odds of developing SARS-CoV-2 infection (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.41-0.71, p < 0.0001). Among patients who developed COVID-19, UDCA use was associated with reduced disease severity, including symptomatic COVID-19 (aOR 0.54, 95% CI 0.39-0.73, p < 0.0001), at least moderate COVID-19 (aOR 0.51, 95% CI 0.32-0.81, p = 0.005), and severe or critical COVID-19 (aOR 0.48, 95% CI 0.25-0.94, p = 0.03). CONCLUSIONS: In participants with cirrhosis, UDCA exposure was associated with both a decrease in SARS-CoV-2 infection, and reduction in symptomatic, at least moderate, and severe/critical COVID-19.","journal":"Journal of Internal Medicine","year":2023,"id":321878,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":42,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9568,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1035265,"name":"Dustin Bastaich","orcid":null,"position":1,"is_corresponding":false},{"id":226671,"name":"Gwilym J. Webb","orcid":"0000-0002-0710-5644","position":2,"is_corresponding":false},{"id":617878,"name":"Teresa Brevini","orcid":"0000-0002-3581-5379","position":3,"is_corresponding":false},{"id":226653,"name":"Andrew M. Moon","orcid":"0000-0001-7163-2062","position":4,"is_corresponding":false},{"id":1034725,"name":"Raphaella Ferreira","orcid":"0000-0003-4990-4839","position":5,"is_corresponding":false},{"id":1035266,"name":"Allison Chin","orcid":null,"position":6,"is_corresponding":false},{"id":253981,"name":"David E. Kaplan","orcid":"0000-0002-3839-336X","position":7,"is_corresponding":false},{"id":406284,"name":"Tamar H. Taddei","orcid":"0000-0002-6500-1739","position":8,"is_corresponding":false},{"id":110279,"name":"Marina Serper","orcid":"0000-0003-4899-2160","position":9,"is_corresponding":false},{"id":298804,"name":"Nadim Mahmud","orcid":"0000-0003-1889-3954","position":10,"is_corresponding":false},{"id":350795,"name":"Yangyang Deng","orcid":"0000-0001-9981-1425","position":11,"is_corresponding":false},{"id":598300,"name":"Hann‐Hsiang Chao","orcid":"0000-0003-1096-0884","position":12,"is_corresponding":false},{"id":104248,"name":"Fotios Sampaziotis","orcid":"0000-0003-0812-7586","position":13,"is_corresponding":false},{"id":350793,"name":"Bassam Dahman","orcid":"0000-0001-7209-5369","position":14,"is_corresponding":false},{"id":264159,"name":"Binu V. John","orcid":"0000-0002-2002-9682","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T01:07:37.596550Z","pmid":"37018129","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}