Secondary sclerosing cholangitis as cause of persistent jaundice in patients with severe COVID-19.
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.Keywords
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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