{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:19:35Z","timestamp":1792030775465,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Studies have demonstrated that reducing farnesoid X receptor activity with ursodeoxycholic acid (UDCA) downregulates angiotensin\u2010converting 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\u2010CoV\u20102) into the host cell. This offers a potential novel target against coronavirus disease 2019 (COVID\u201019). The objective of our study was to compare the association between UDCA exposure and SARS\u2010CoV\u20102 infection, as well as varying severities of COVID\u201019, in a large national cohort of participants with cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010CoV\u20102 infection, symptomatic, at least moderate, severe, or critical COVID\u201019, and COVID\u201019\u2010related death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We compared 1607 participants with cirrhosis who were on UDCA, with 1607 PS\u2010matched controls. On multivariable logistic regression, UDCA exposure was associated with reduced odds of developing SARS\u2010CoV\u20102 infection (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.41\u20130.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). Among patients who developed COVID\u201019, UDCA use was associated with reduced disease severity, including symptomatic COVID\u201019 (aOR 0.54, 95% CI 0.39\u20130.73,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001), at least moderate COVID\u201019 (aOR 0.51, 95% CI 0.32\u20130.81,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.005), and severe or critical COVID\u201019 (aOR 0.48, 95% CI 0.25\u20130.94,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In participants with cirrhosis, UDCA exposure was associated with both a decrease in SARS\u2010CoV\u20102 infection, and reduction in symptomatic, at least moderate, and severe\/critical COVID\u201019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joim.13630","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T12:54:11Z","timestamp":1680699251000},"page":"636-647","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Ursodeoxycholic acid is associated with a reduction in SARS\u2010CoV\u20102 infection and reduced severity of COVID\u201019 in patients with cirrhosis"],"prefix":"10.1111","volume":"293","author":[{"given":"Binu V.","family":"John","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Miami VA Medical System  Miami Florida USA"},{"name":"Division of Digestive Health and Liver Diseases University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin","family":"Bastaich","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Policy Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwilym","family":"Webb","sequence":"additional","affiliation":[{"name":"Cambridge Liver Unit Cambridge University Hospital, NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Brevini","sequence":"additional","affiliation":[{"name":"Wellcome\u2014MRC Cambridge Stem Cell Institute  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Moon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphaella D.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Miami VA Medical System  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M.","family":"Chin","sequence":"additional","affiliation":[{"name":"Herbert Wertheim Florida International University  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Section of Gastroenterology and Hepatology Corporal Michael J. 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