Division of Gastroenterology and HepatologyDepartment of Medicine IIIMedical University of ViennaViennaAustria.
Vienna Hepatic Hemodynamic LabDivision of Gastroenterology and HepatologyDepartment of Medicine IIIMedical University of ViennaViennaAustria.
Hepatology. 2022 Dec;76(6):1563-1575. doi: 10.1002/hep.32582. Epub 2022 Jun 18.
Cholestasis is associated with disease severity and worse outcome in COVID-19. Cases of secondary sclerosing cholangitis (SSC) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described.
Hospitalized patients with COVID-19 between 03/2020 and 07/2021 were included. Patients were stratified as having (i) no chronic liver disease (CLD), (ii) non-advanced CLD (non-ACLD), or (iii) advanced CLD (ACLD). Patients with CLD and non-COVID-19 pneumonia were matched to patients with CLD and COVID-19 as a control cohort. Liver chemistries before (Pre) and at first, second, and third blood withdrawal after SARS-CoV-2 infection (T1-T3) and at last available time point (last) were recorded. A total of 496 patients were included. In total, 13.1% (n = 65) had CLD (non-ACLD: 70.8%; ACLD: 29.2%); the predominant etiology was NAFLD/NASH (60.0%). COVID-19-related liver injury was more common among patients with CLD (24.6% vs. 10.6%; p = 0.001). After SARS-CoV-2 infection, patients with CLD exhibited progressive cholestasis with persistently increasing levels of alkaline phosphatase (Pre: 91.0 vs. T1: 121.0 vs. last: 175.0 U/L; p < 0.001) and gamma-glutamyl transferase (Pre: 95.0 vs. T1: 135.0 vs. last: 202.0 U/L; p = 0.001). A total of 23.1% of patients with CLD (n = 15/65) developed cholestatic liver failure (cholestasis plus bilirubin ≥6 mg/dl) during COVID-19, and 15.4% of patients (n = 10/65) developed SSC. SSC was significantly more frequent among patients with CLD and COVID-19 than in patients with CLD and non-COVID-19 pneumonia (p = 0.040). COVID-19-associated SSC occurred predominantly in patients with NAFLD/NASH and metabolic risk factors. A total of 26.3% (n = 5/19) of patients with ACLD experienced hepatic decompensation after SARS-CoV-2 infection.
About 20% of patients with CLD develop progressive cholestasis after SARS-CoV-2 infection. Patients with NAFLD/NASH and metabolic risk factors are at particular risk for developing cholestatic liver failure and/or SSC after COVID-19.
胆汁淤积与 COVID-19 患者的疾病严重程度和预后不良相关。有研究描述了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染后发生的继发性硬化性胆管炎（SSC）病例。
本研究纳入了 2020 年 3 月至 2021 年 7 月期间住院的 COVID-19 患者。患者分为无慢性肝病（CLD）（i）、非进展性 CLD（非 ACLD）（ii）或进展性 CLD（ACLD）（iii）。将 CLD 合并 COVID-19 的患者与 CLD 合并非 COVID-19 肺炎的患者相匹配作为对照队列。记录 SARS-CoV-2 感染前（Pre）和感染后第 1、2、3 次采血（T1-T3）以及最后一次可用时间点（last）的肝生化指标。共纳入 496 例患者。共有 13.1%（n=65）患有 CLD（非 ACLD：70.8%；ACLD：29.2%）；主要病因是非酒精性脂肪性肝病/非酒精性脂肪性肝炎（NAFLD/NASH）（60.0%）。与无 CLD 的患者相比，CLD 患者的 COVID-19 相关肝损伤更为常见（24.6% vs. 10.6%；p=0.001）。在 SARS-CoV-2 感染后，CLD 患者出现进行性胆汁淤积，碱性磷酸酶（Pre：91.0 vs. T1：121.0 vs. last：175.0 U/L；p<0.001）和γ-谷氨酰转移酶（Pre：95.0 vs. T1：135.0 vs. last：202.0 U/L；p=0.001）持续升高。在 COVID-19 期间，共有 23.1%（n=15/65）的 CLD 患者（n=15/65）发展为胆汁淤积性肝衰竭（胆汁淤积合并胆红素≥6mg/dl），15.4%（n=10/65）的患者发展为 SSC。与 CLD 合并非 COVID-19 肺炎的患者相比，CLD 合并 COVID-19 的患者 SSC 更为常见（p=0.040）。COVID-19 相关的 SSC 主要发生在患有 NAFLD/NASH 和代谢危险因素的患者中。在 SARS-CoV-2 感染后，共有 26.3%（n=5/19）的 ACLD 患者出现肝功能失代偿。
约 20%的 CLD 患者在 SARS-CoV-2 感染后出现进行性胆汁淤积。患有 NAFLD/NASH 和代谢危险因素的患者在感染 COVID-19 后发生胆汁淤积性肝衰竭和/或 SSC 的风险尤其高。
