tetano
Editor, Senior Moderator
Hepatology
. 2022 May 21.
doi: 10.1002/hep.32582. Online ahead of print.
Progressive cholestasis and associated sclerosing cholangitis are frequent complications of COVID-19 in chronic liver disease patients
Lukas Hartl[SUP] 1 2 [/SUP], Katharina Haslinger[SUP] 1 2 [/SUP], Martin Angerer[SUP] 1 2 [/SUP], Georg Semmler[SUP] 1 2 [/SUP], Mathias Schneeweiss-Gleixner[SUP] 1 [/SUP], Mathias Jachs[SUP] 1 2 [/SUP], Benedikt Simbrunner[SUP] 1 2 3 [/SUP], David Josef Maria Bauer[SUP] 1 2 [/SUP], Ernst Eigenbauer[SUP] 4 [/SUP], Robert Strassl[SUP] 5 [/SUP], Monika Breuer[SUP] 5 [/SUP], Oliver Kimberger[SUP] 6 [/SUP], Daniel Laxar[SUP] 6 [/SUP], Katharina Lampichler[SUP] 7 [/SUP], Emina Halilbasic[SUP] 1 [/SUP], Albert Friedrich Stättermayer[SUP] 1 2 [/SUP], Ahmed Ba-Ssalamah[SUP] 7 [/SUP], Mattias Mandorfer[SUP] 1 2 [/SUP], Bernhard Scheiner[SUP] 1 2 [/SUP], Thomas Reiberger[SUP] 1 2 3 [/SUP], Michael Trauner[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Cholestasis is associated with disease severity and worse outcome in coronavirus disease of 2019 (COVID-19). Cases of secondary sclerosing cholangitis (SSC) after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been described.
Methods: Hospitalized patients with COVID-19 between 03/2020 and 07/2021 were included. Patients were stratified as having (i) no chronic liver disease (CLD), (ii) non-advanced (non-ACLD), or (iii) advanced chronic liver disease (ACLD). CLD patients with non-COVID-19 pneumonia were matched to CLD patients with COVID-19 as a control cohort. Liver chemistries before (Pre), at first, second and third blood withdrawal after SARS-CoV-2 infection (T1-T3) and at last available time point (last) were recorded.
Results: 496 patients were included. 13.1% (n=65) had CLD (non-ACLD: 70.8%; ACLD: 29.2%); the predominant etiology was non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH; 60.0%). COVID-19-related liver injury was more common among CLD patients (24.6% vs. 10.6%; p=0.001). After SARS-CoV-2 infection, CLD patients exhibited progressive cholestasis with persistently increasing levels of alkaline phosphatase (ALP; Pre: 91.0 vs. T1: 121.0 vs. last: 175.0U/L; p<0.001) and gamma-glutamyl transferase (GGT; Pre: 95.0 vs. T1: 135.0 vs. last: 202.0U/L; p=0.001). 23.1% of CLD patients (n=15/65) developed cholestatic liver failure (cholestasis plus bilirubin ≥6mg/dL) during COVID-19 and 15.4% of patients (n=10/65) developed SSC. SSC was significantly more frequent among CLD patients with COVID-19 than in CLD patients with non-COVID-19 pneumonia (p=0.040). COVID-19-associated SSC occurred predominantly in NAFLD/NASH patients with metabolic risk factors. 26.3% (n=5/19) of ACLD patients experienced hepatic decompensation after SARS-CoV-2 infection.
Conclusions: About 20% of CLD patients develop progressive cholestasis after SARS-CoV-2 infection. NAFLD/NASH patients with metabolic risk factors are at particular risk for developing cholestatic liver failure and/or SSC after COVID-19.
. 2022 May 21.
doi: 10.1002/hep.32582. Online ahead of print.
Progressive cholestasis and associated sclerosing cholangitis are frequent complications of COVID-19 in chronic liver disease patients
Lukas Hartl[SUP] 1 2 [/SUP], Katharina Haslinger[SUP] 1 2 [/SUP], Martin Angerer[SUP] 1 2 [/SUP], Georg Semmler[SUP] 1 2 [/SUP], Mathias Schneeweiss-Gleixner[SUP] 1 [/SUP], Mathias Jachs[SUP] 1 2 [/SUP], Benedikt Simbrunner[SUP] 1 2 3 [/SUP], David Josef Maria Bauer[SUP] 1 2 [/SUP], Ernst Eigenbauer[SUP] 4 [/SUP], Robert Strassl[SUP] 5 [/SUP], Monika Breuer[SUP] 5 [/SUP], Oliver Kimberger[SUP] 6 [/SUP], Daniel Laxar[SUP] 6 [/SUP], Katharina Lampichler[SUP] 7 [/SUP], Emina Halilbasic[SUP] 1 [/SUP], Albert Friedrich Stättermayer[SUP] 1 2 [/SUP], Ahmed Ba-Ssalamah[SUP] 7 [/SUP], Mattias Mandorfer[SUP] 1 2 [/SUP], Bernhard Scheiner[SUP] 1 2 [/SUP], Thomas Reiberger[SUP] 1 2 3 [/SUP], Michael Trauner[SUP] 1 [/SUP]
Affiliations
- PMID: 35596929
- DOI: 10.1002/hep.32582
Abstract
Background: Cholestasis is associated with disease severity and worse outcome in coronavirus disease of 2019 (COVID-19). Cases of secondary sclerosing cholangitis (SSC) after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been described.
Methods: Hospitalized patients with COVID-19 between 03/2020 and 07/2021 were included. Patients were stratified as having (i) no chronic liver disease (CLD), (ii) non-advanced (non-ACLD), or (iii) advanced chronic liver disease (ACLD). CLD patients with non-COVID-19 pneumonia were matched to CLD patients with COVID-19 as a control cohort. Liver chemistries before (Pre), at first, second and third blood withdrawal after SARS-CoV-2 infection (T1-T3) and at last available time point (last) were recorded.
Results: 496 patients were included. 13.1% (n=65) had CLD (non-ACLD: 70.8%; ACLD: 29.2%); the predominant etiology was non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH; 60.0%). COVID-19-related liver injury was more common among CLD patients (24.6% vs. 10.6%; p=0.001). After SARS-CoV-2 infection, CLD patients exhibited progressive cholestasis with persistently increasing levels of alkaline phosphatase (ALP; Pre: 91.0 vs. T1: 121.0 vs. last: 175.0U/L; p<0.001) and gamma-glutamyl transferase (GGT; Pre: 95.0 vs. T1: 135.0 vs. last: 202.0U/L; p=0.001). 23.1% of CLD patients (n=15/65) developed cholestatic liver failure (cholestasis plus bilirubin ≥6mg/dL) during COVID-19 and 15.4% of patients (n=10/65) developed SSC. SSC was significantly more frequent among CLD patients with COVID-19 than in CLD patients with non-COVID-19 pneumonia (p=0.040). COVID-19-associated SSC occurred predominantly in NAFLD/NASH patients with metabolic risk factors. 26.3% (n=5/19) of ACLD patients experienced hepatic decompensation after SARS-CoV-2 infection.
Conclusions: About 20% of CLD patients develop progressive cholestasis after SARS-CoV-2 infection. NAFLD/NASH patients with metabolic risk factors are at particular risk for developing cholestatic liver failure and/or SSC after COVID-19.