TY - JOUR
T1 - Hepatobiliary long-term consequences of COVID-19
T2 - dramatically increased rate of secondary sclerosing cholangitis in critically ill COVID-19 patients
AU - Leonhardt, Silke
AU - Jürgensen, Christian
AU - Frohme, Josephine
AU - Grajecki, Donata
AU - Adler, Andreas
AU - Sigal, Michael
AU - Leonhardt, Julia
AU - Voll, Julian M.
AU - Kruse, Jan Matthias
AU - Körner, Roland
AU - Eckardt, Kai Uwe
AU - Janssen, Hans Joachim
AU - Gebhardt, Volker
AU - Schmittner, Marc D.
AU - Hippenstiel, Stefan
AU - Witzenrath, Martin
AU - Suttorp, Norbert
AU - Helbig, Elisa T.
AU - Lippert, Lena J.
AU - Stubbemann, Paula
AU - Tober-Lau, Pinkus
AU - Hillus, David
AU - Haenel, Sascha S.
AU - Horn, Alexandra
AU - Koch, Willi M.
AU - Olk, Nadine
AU - Mittermaier, Mirja
AU - Steinbeis, Fridolin
AU - Lingscheid, Tilman
AU - Temmesfeld-Wollbrück, Bettina
AU - Zoller, Thomas
AU - Müller-Redetzky, Holger
AU - Uhrig, Alexander
AU - Grund, Daniel
AU - Ruwwe-Glösenkamp, Christoph
AU - Stegemann, Miriam S.
AU - Heim, Katrin M.
AU - Hübner, Ralf H.
AU - Drosten, Christian
AU - Corman, Victor M.
AU - Opitz, Bastian
AU - Möckel, Martin
AU - Balzer, Felix
AU - Spies, Claudia
AU - Weber-Carstens, Steffen
AU - Dang-Heine, Chantip
AU - Hummel, Michael
AU - Schwanitz, Georg
AU - Behrens, Uwe D.
AU - von Kalle, Christof
AU - Pa-COVID-19 collaborative study group
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Background: Increasing evidence suggests that secondary sclerosing cholangitis (SSC), which can lead to cirrhosis or liver failure, may be a hepatobiliary long-term complication of COVID-19. The aim of this study was to estimate the frequency and outcome of this COVID-19 sequela and to identify possible risk factors. Methods: This observational study, conducted at University Hospital Charité Berlin and Unfallkrankenhaus Berlin, Germany, involved hospitalized patients with COVID-19 pneumonia, including 1082 ventilated COVID-19 patients. We compared COVID-19 patients who developed SSC with a COVID-19 control group by univariate and multivariate analyses. Results: SSC occurrence after COVID-19 was observed exclusively in critically ill patients with invasive ventilation, albeit with extreme clustering among them. One in every 43 invasively ventilated COVID-19 patients developed this complication. Risk factors preceding the development of secondary sclerosing cholangitis in critically ill COVID-19 patients (SSC-CIP) were signs of systemic reduced blood oxygen supply (e.g., low PaO2/FiO2, ischemic organ infarctions), multi-organ failure (high SOFA score) at admission, high fibrinogen levels and intravenous ketamine use. Multivariate analysis confirmed fibrinogen and increased plasma lactate dehydrogenase as independent risk factors associated with cholangiopathy onset. The 1-year transplant-free survival rate of COVID-19-associated SSC-CIP was 40%. Conclusions: COVID-19 causes SSC-CIP in a substantial proportion of critically ill patients. SSC-CIP most likely develops due to severe tissue hypoxia and fibrinogen-associated circulatory disturbances. A significant increase of patients with SSC-CIP is to be expected in the post-COVID era.
AB - Background: Increasing evidence suggests that secondary sclerosing cholangitis (SSC), which can lead to cirrhosis or liver failure, may be a hepatobiliary long-term complication of COVID-19. The aim of this study was to estimate the frequency and outcome of this COVID-19 sequela and to identify possible risk factors. Methods: This observational study, conducted at University Hospital Charité Berlin and Unfallkrankenhaus Berlin, Germany, involved hospitalized patients with COVID-19 pneumonia, including 1082 ventilated COVID-19 patients. We compared COVID-19 patients who developed SSC with a COVID-19 control group by univariate and multivariate analyses. Results: SSC occurrence after COVID-19 was observed exclusively in critically ill patients with invasive ventilation, albeit with extreme clustering among them. One in every 43 invasively ventilated COVID-19 patients developed this complication. Risk factors preceding the development of secondary sclerosing cholangitis in critically ill COVID-19 patients (SSC-CIP) were signs of systemic reduced blood oxygen supply (e.g., low PaO2/FiO2, ischemic organ infarctions), multi-organ failure (high SOFA score) at admission, high fibrinogen levels and intravenous ketamine use. Multivariate analysis confirmed fibrinogen and increased plasma lactate dehydrogenase as independent risk factors associated with cholangiopathy onset. The 1-year transplant-free survival rate of COVID-19-associated SSC-CIP was 40%. Conclusions: COVID-19 causes SSC-CIP in a substantial proportion of critically ill patients. SSC-CIP most likely develops due to severe tissue hypoxia and fibrinogen-associated circulatory disturbances. A significant increase of patients with SSC-CIP is to be expected in the post-COVID era.
KW - COVID-19 associated SSC-CIP
KW - COVID-19 cholangiopathy
KW - COVID-19 long-term consequences
KW - Ischemic cholangiopathy
KW - Secondary sclerosing cholangitis in critically ill patients
UR - http://www.scopus.com/inward/record.url?scp=85153939771&partnerID=8YFLogxK
U2 - 10.1007/s12072-023-10521-0
DO - 10.1007/s12072-023-10521-0
M3 - Article
C2 - 37119516
AN - SCOPUS:85153939771
SN - 1936-0533
VL - 17
SP - 1610
EP - 1625
JO - Hepatology International
JF - Hepatology International
IS - 6
ER -