tetano
Editor, Senior Moderator
Clin Infect Dis
. 2022 Jul 9;ciac565.
doi: 10.1093/cid/ciac565. Online ahead of print.
Secondary sclerosing cholangitis following COVID-19 disease: a multicenter retrospective study
Peter Hunyady[SUP] 1 [/SUP], Lea Streller[SUP] 2 [/SUP], Darius F Rüther[SUP] 3 [/SUP], Sara Reinartz Groba[SUP] 4 [/SUP], Dominik Bettinger[SUP] 5 [/SUP], Daniel Fitting[SUP] 6 [/SUP], Karim Hamesch[SUP] 7 [/SUP], Jens U Marquardt[SUP] 8 [/SUP], Victoria T Mücke[SUP] 1 [/SUP], Fabian Finkelmeier[SUP] 1 [/SUP], Asieb Sekandarzad[SUP] 9 [/SUP], Tobias Wengenmayer[SUP] 9 [/SUP], Ayoub Bounidane[SUP] 1 [/SUP], Felicitas Weiss[SUP] 7 [/SUP], Kai Henrik Peiffer[SUP] 1 [/SUP], Bernhard Schlevogt[SUP] 4 [/SUP], Stefan Zeuzem[SUP] 1 [/SUP], Oliver Waidmann[SUP] 1 [/SUP], Marcus Hollenbach[SUP] 10 [/SUP], Martha M Kirstein[SUP] 8 [/SUP], Johannes Kluwe[SUP] 3 [/SUP], Fabian Kütting[SUP] 2 [/SUP], Marcus M Mücke[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Secondary sclerosing cholangitis (SSC) is a rare disease with poor prognosis. Cases of SSC have been reported following coronavirus disease 2019 (COVID-19), COVID-SSC.
Aims: Aim of this study was to compare COVID-SSC to SSC in critically ill patients (SSC-CIP) and to assess factors influencing transplant-free survival.
Methods: In this retrospective, multicenter study involving 127 patients with SSC from 9 tertiary care centers in Germany, COVID-SSC was compared to SSC-CIP and logistic regression analyses were performed investigating factors impacting transplant-free survival.
Results: 24 patients had COVID-SSC, 77 patients SSC-CIP and 26 patients had other forms of SSC. COVID-SSC developed after a median of 91 days following COVID-19 diagnosis. All patients had received extensive intensive care treatment (median days of mechanical ventilation 48). Patients with COVID-SSC and SSC-CIP were comparable in most of the clinical parameters and transplant-free survival was not different from other forms of SSC (P = 0.443 in log-rank test). In the overall cohort, the use of ursodeoxycholic acid (UDCA, OR 0.36, 95%-CI 0.16-0.80, P = 0.013; P < 0.001 in log-rank test) and high serum albumin levels (OR 0.40, 95%-CI 0.17-0.96, P = 0.040) were independently associated with an increased transplant-free survival, while the presence of liver cirrhosis (OR 2.52, 95%-CI 1.01-6.25, P = 0.047) was associated with worse outcome. MDRO colonization or infection did not impact patients' survival.
Conclusions: COVID-SSC and CIP-SSC share the same clinical phenotype, course of the disease and risk factors for its development. UDCA may be a promising therapeutic option in SSC, though future prospective trials need to confirm our findings.
Keywords: SARS-CoV-2; cholangiopathy; cirrhosis; intensive care unit; multidrug-resistance.
. 2022 Jul 9;ciac565.
doi: 10.1093/cid/ciac565. Online ahead of print.
Secondary sclerosing cholangitis following COVID-19 disease: a multicenter retrospective study
Peter Hunyady[SUP] 1 [/SUP], Lea Streller[SUP] 2 [/SUP], Darius F Rüther[SUP] 3 [/SUP], Sara Reinartz Groba[SUP] 4 [/SUP], Dominik Bettinger[SUP] 5 [/SUP], Daniel Fitting[SUP] 6 [/SUP], Karim Hamesch[SUP] 7 [/SUP], Jens U Marquardt[SUP] 8 [/SUP], Victoria T Mücke[SUP] 1 [/SUP], Fabian Finkelmeier[SUP] 1 [/SUP], Asieb Sekandarzad[SUP] 9 [/SUP], Tobias Wengenmayer[SUP] 9 [/SUP], Ayoub Bounidane[SUP] 1 [/SUP], Felicitas Weiss[SUP] 7 [/SUP], Kai Henrik Peiffer[SUP] 1 [/SUP], Bernhard Schlevogt[SUP] 4 [/SUP], Stefan Zeuzem[SUP] 1 [/SUP], Oliver Waidmann[SUP] 1 [/SUP], Marcus Hollenbach[SUP] 10 [/SUP], Martha M Kirstein[SUP] 8 [/SUP], Johannes Kluwe[SUP] 3 [/SUP], Fabian Kütting[SUP] 2 [/SUP], Marcus M Mücke[SUP] 1 [/SUP]
Affiliations
- PMID: 35809032
- DOI: 10.1093/cid/ciac565
Abstract
Background: Secondary sclerosing cholangitis (SSC) is a rare disease with poor prognosis. Cases of SSC have been reported following coronavirus disease 2019 (COVID-19), COVID-SSC.
Aims: Aim of this study was to compare COVID-SSC to SSC in critically ill patients (SSC-CIP) and to assess factors influencing transplant-free survival.
Methods: In this retrospective, multicenter study involving 127 patients with SSC from 9 tertiary care centers in Germany, COVID-SSC was compared to SSC-CIP and logistic regression analyses were performed investigating factors impacting transplant-free survival.
Results: 24 patients had COVID-SSC, 77 patients SSC-CIP and 26 patients had other forms of SSC. COVID-SSC developed after a median of 91 days following COVID-19 diagnosis. All patients had received extensive intensive care treatment (median days of mechanical ventilation 48). Patients with COVID-SSC and SSC-CIP were comparable in most of the clinical parameters and transplant-free survival was not different from other forms of SSC (P = 0.443 in log-rank test). In the overall cohort, the use of ursodeoxycholic acid (UDCA, OR 0.36, 95%-CI 0.16-0.80, P = 0.013; P < 0.001 in log-rank test) and high serum albumin levels (OR 0.40, 95%-CI 0.17-0.96, P = 0.040) were independently associated with an increased transplant-free survival, while the presence of liver cirrhosis (OR 2.52, 95%-CI 1.01-6.25, P = 0.047) was associated with worse outcome. MDRO colonization or infection did not impact patients' survival.
Conclusions: COVID-SSC and CIP-SSC share the same clinical phenotype, course of the disease and risk factors for its development. UDCA may be a promising therapeutic option in SSC, though future prospective trials need to confirm our findings.
Keywords: SARS-CoV-2; cholangiopathy; cirrhosis; intensive care unit; multidrug-resistance.