Secondary Sclerosing Cholangitis Following Coronavirus Disease 2019 (COVID-19): A Multicenter Retrospective Study

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.

Folgen nach SARS-CoV-2-Infektion einschließlich Post-COVID-Syndrom

“…Als primärer Auslöser wird bislang eine ischämische Schädigung vermutet. Rezidivierende biliäre Infektionen und eine Kolonisation mit multiresistenten Organismen tragen letztlich zu einem komplikativen Verlauf (Tod, Lebertransplantation) bei [ 29 ].

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Risk of New-Onset Liver Injuries Due to COVID-19 in Preexisting Hepatic Conditions—Review of the Literature

“…The incidence of SSC-CIP is directly proportional to ICU stay, even in patients without any history of biliary or liver disease. SSC-CIP is defined as a significant complication of ICU stay [ 66 ].…”

“…One study published this year compared 24 patients with SSC after COVID-19 with 77 patients with SSC-CIP [ 66 ]. The median for SSC development was 91 days after COVID-19.…”

“…There were no differences in most of the symptoms and transplant-free survival. Ursodeoxycholic acid treatment and albumin were administered [ 66 ]. Even though there are similarities between these two entities, the authors concluded that the course of the disease and the risk factors are unrelated between the two pathologies, and ursodeoxycholic acid administration needs further validation [ 66 ].…”

Forms of cholangitis to be considered after SARS-CoV-2 infection

“…In some cases, orthotopic liver transplantation was considered for treatment [ 9 ]. Another retrospective analysis comprising 24 patients with COVID-secondary sclerosing cholangitis showed that the disease shares the same clinical phenotype, course, and risk factors among critically ill patients who develop secondary sclerosing cholangitis [ 10 ].…”