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Secondary sclerosing cholangitis as cause of persistent jaundice in patients with severe COVID-19.
Bütikofer, Simon; Lenggenhager, Daniela; Wendel Garcia, Pedro D; Maggio, Ewerton M; Haberecker, Martina; Reiner, Cäcilia S; Brüllmann, Gregor; Buehler, Philipp K; Gubler, Christoph; Müllhaupt, Beat; Jüngst, Christoph; Morell, Bernhard.
  • Bütikofer S; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
  • Lenggenhager D; Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
  • Wendel Garcia PD; Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland.
  • Maggio EM; Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
  • Haberecker M; Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
  • Reiner CS; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
  • Brüllmann G; Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland.
  • Buehler PK; Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland.
  • Gubler C; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
  • Müllhaupt B; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
  • Jüngst C; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
  • Morell B; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Liver Int ; 41(10): 2404-2417, 2021 10.
Article in English | MEDLINE | ID: covidwho-1238452
ABSTRACT
BACKGROUND &

AIMS:

Little is known about cholestasis, including its most severe variant secondary sclerosing cholangitis (SSC), in critically ill patients with coronavirus disease 19 (COVID-19). In this study, we analysed the occurrence of cholestatic liver injury and SSC, including clinical, serological, radiological and histopathological findings.

METHODS:

We conducted a retrospective single-centre analysis of all consecutive patients admitted to the intensive care unit (ICU) as a result of severe COVID-19 at the University Hospital Zurich to describe cholestatic injury in these patients. The findings were compared to a retrospective cohort of patients with severe influenza A.

RESULTS:

A total of 34 patients with severe COVID-19 admitted to the ICU were included. Of these, 14 patients (41%) had no cholestasis (group 0), 11 patients (32%, group 1) developed mild and 9 patients (27%, group 2) severe cholestasis. Patients in group 2 had a more complicated disease course indicated by significantly longer ICU stay (median 51 days, IQR 25-86.5) than the other groups (group 0 median 9.5 days, IQR 3.8-18.3, P = .001; and group 1 median 16 days, IQR 8-30, P < .05 respectively). Four patients in group 2 developed SSC compared to none in the influenza A cohort. The available histopathological findings suggest an ischaemic damage to the perihilar bile ducts.

CONCLUSIONS:

The development of SSC represents an important complication of critically ill COVID-19 patients and needs to be considered in the diagnostic work up in prolonged cholestasis. The occurrence of SSC is of interest in the ongoing pandemic since it is associated with considerable morbidity and mortality.
Subject(s)
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cholangitis, Sclerosing / COVID-19 / Jaundice Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Variants Limits: Humans Language: English Journal: Liver Int Journal subject: Gastroenterology Year: 2021 Document Type: Article Affiliation country: Liv.14971

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cholangitis, Sclerosing / COVID-19 / Jaundice Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Variants Limits: Humans Language: English Journal: Liver Int Journal subject: Gastroenterology Year: 2021 Document Type: Article Affiliation country: Liv.14971