CLINICAL FEATURES AND CHARACTERISTIC OF CHOLANGIOPATHY AFTER SEVERE COVID-19

ABSTRACT

Introduction Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2), can commonly lead to abnormal liver tests, mostly transaminase elevation. Recently, a novel entity of cholangiopathy was discovered in patients who recovered from critical COVID-19 infection. However, understanding of this disease is limited due to its rarity. Methods We reviewed Pubmed, Embase, and Web of Science Core Collection databases from inception to Nov 30th, 2021, to identify studies reporting cholangiopathy after severe COVID-19 infection. “SARS-CoV-2” or “COVID-19” with “cholangiopathy” were used as keywords to search. Our study is to summarize the clinical features and characteristics of cholangiopathy after severe COVID-19 illness. Results Literature review identified 15 articles including 33 patients for reviews. Most studies were performed in the United States. The mean age of participants from all studies is 52.17 ± 13.98 years old. Among the 33 included patients, the majority are male (29, 88%) and the common medical histories include hypertension (n=11), obesity (n=8), and diabetes mellitus (n=8). The length of stay (LOS) during hospitalization was prolonged with a mean of 80.23 ± 33.14 days. All patients were intubated and put on mechanical ventilation during medical intensive care stay with 12 patients having a history of endotracheal cardiac output monitoring. The mean peak of serum alkaline phosphatase, aspartate aminotransferase, alanine transaminase and total bilirubin were 2106.96 (U/l) ± 784.04, 1456.09 (U/l) ± 2325.10, 983.57 (U/l) ± 1244.44 and 14.04 (mg/dl) ± 8.41, respectively. Cholangiopathy after severe COVID illness mimics secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography studies with ductal beading but the presence of unique severe cholangiocyte injury and intrahepatic microangiopathy is suggestive of direct hepatic injury due to COVID-19. In terms of outcome, 7 patients were documented as deceased. Eight patients underwent liver transplantation (Table 1). Discussion Cholangiopathy is a late complication of severe COVID-19 after prolonged ICU stay with potential for long-term liver morbidity and liver failure needing liver transplantation. Further studies are warranted to understand pathogenesis, natural history, therapeutic interventions, and prognostic indicators. (Table Presented)