Department of Internal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
Clinic for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Clin Infect Dis. 2023 Feb 8;76(3):e179-e187. doi: 10.1093/cid/ciac565.
Secondary sclerosing cholangitis (SSC) is a rare disease with poor prognosis. Cases of SSC have been reported following coronavirus disease 2019 (COVID-SSC). The 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.
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.
Twenty-four patients had COVID-SSC, 77 patients SSC-CIP, and 26 patients 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 = .443, log-rank test). In the overall cohort, the use of ursodeoxycholic acid (UDCA) (odds ratio [OR], 0.36 [95% confidence interval {CI}, .16-.80], P = .013; log-rank P < .001) and high serum albumin levels (OR, 0.40 [95% CI, .17-.96], P = .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 = .047) was associated with worse outcome. Multidrug-resistant organism (MDRO) colonization or infection did not impact patients' survival.
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 are needed to confirm our findings.
继发硬化性胆管炎（SSC）是一种预后较差的罕见疾病。有冠状病毒病 2019（COVID-SSC）后发生 SSC 的报道。本研究旨在比较危重症继发硬化性胆管炎（SSC-CIP）患者中的 COVID-SSC 与 SSC，并评估影响无移植生存的因素。
在这项涉及德国 9 家三级护理中心的 127 例 SSC 患者的回顾性多中心研究中，将 COVID-SSC 与 SSC-CIP 进行比较，并进行逻辑回归分析，以调查影响无移植生存的因素。
24 例患者患有 COVID-SSC，77 例患者患有 SSC-CIP，26 例患者患有其他形式的 SSC。COVID-SSC 在 COVID-19 诊断后中位 91 天发展。所有患者均接受了广泛的重症监护治疗（机械通气中位数天数，48 天）。COVID-SSC 和 SSC-CIP 患者在大多数临床参数方面无差异，无移植生存与其他形式的 SSC 无差异（P =.443，对数秩检验）。在整个队列中，熊去氧胆酸（UDCA）的使用（优势比 [OR]，0.36 [95%置信区间 {CI}，0.16-0.80]，P =.013；对数秩 P <.001）和高血清白蛋白水平（OR，0.40 [95% CI，0.17-0.96]，P =.040）与移植无生存相关增加，而肝硬化（OR，2.52 [95% CI，1.01-6.25]，P =.047）与预后较差相关。多药耐药菌（MDRO）定植或感染不影响患者的生存。
COVID-SSC 和 CIP-SSC 具有相同的临床表型、疾病过程和发病风险因素。UDCA 可能是 SSC 的一种有前途的治疗选择，尽管需要未来的前瞻性试验来证实我们的发现。
