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Patients with chronic liver disease may experience liver complications as a result of severe COVID-19. A study by a research team led by Lukas Hartl, Thomas Reiberger and Michael Trauner of the Division of Gastroenterology and Hepatology of MedUni in Vienna and the University Hospital of Vienna found that an increase in cholestasis parameters and damage posterior to the bile ducts, the so-called secondary. Sclerosing cholangitis (SSC) develops with surprising frequency in patients with pre-existing liver disease. SSC occurs significantly more frequently after COVID-19 than after other serious illnesses. The study was published in Hepatology.
In the context of a cross-sectional study, a research team led by Lukas Hartl, Thomas Reiberger and Michael Trauner of the Division of Gastroenterology and Hepatology of the Department of Medicine III of MedUni Vienna and the University Hospital of Vienna analyzed the liver chemistry of 496 hospitalized. patients with COVID-19. Sixty-five of these patients had pre-existing liver disease, such as fatty liver disease, cirrhosis, or hepatocellular carcinoma. The aim of the study was to accurately describe the trajectory of liver chemistry in these patients after infection.
An increase in transaminases at the onset of COVID-19 was found to be common. These enzymes, AST (aspartate aminotransferase) and ALT (alanine aminotransferase), are considered markers of liver cell damage. These values were later normalized: a phenomenon that has already been described in previous studies. In contrast, the parameters of biliary congestion (cholestasis), alkaline phosphatase (AP), and GGT (gamma glutamyl transferase) increased progressively in many patients during the course of infection without subsequent regression. Of these patients, 23.1% even suffered from cholestatic liver failure, that is, liver failure associated with biliary stasis.
The researchers used imaging (MRCP) and endoscopic (ERCP) techniques to show that irreversible alterations in the bile ducts of patients, also known as secondary sclerosing cholangitis (SSC), had also occurred. This disease also occurs after other critical illness states, such as oxygen deprivation or severe infection. The course is usually progressive and can lead to a liver transplant and even death. Fifteen percent of patients with chronic liver disease with severe COVID-19 developed SSC. Many of these patients had pre-existing conditions such as fatty liver disease, diabetes, obesity or hypertension, and in some cases required months of intensive care due to COVID-19.
In summary, the study found that COVID-19 often leads to a progressive increase in the parameters of cholestasis, cholestatic liver failure, and even SSC in 15% of patients. Lukas Hartl explained: “Using data from our comparison group of ICU patients who did not have COVID-19, we were able to show that SSC was significantly more common in patients with COVID-19. Non-COVID-19 patients were also seriously ill in the ICU and were often intubated for long periods of time. However, few of those not affected by COVID-19 developed SSC. “
The causes are not yet clear, but there is evidence that SARS-CoV-2 itself can damage the liver and bile ducts. Thomas Reiberger said: “It is useful, in any case, to monitor closely the values of liver function in ICU patients during or after COVID-19. Therapeutically, endoscopy (ERCP) of the bile ducts can be used. “To dilate constrictions and eliminate other obstructions by drainage, if necessary. Rapid administration of appropriate drugs and prevention of oxygen deprivation as part of intensive care play a critical role.” There is currently no effective pharmacological treatment for sclerosing cholangitis, but according to Michael Trauner, the division is focused on developing new therapeutic approaches.
Lukas Hartl said additional studies were planned to analyze the long-term course of cholestasis parameters in patients with long COVID-19 and late liver-related COVID-19 sequelae in patients without pre-existing liver disease. This is because there is already evidence that COVID-19 is also associated with elevated liver enzymes in this group of patients.
A strong link has been found between abnormal liver tests and poor COVID-19 results. More information: Lukas Hartl et al, Progressive cholestasis and associated sclerosing cholangitis are common complications of COVID-19 in patients with chronic liver disease. Hepatology (2022). DOI: 10.1002 / hep.32582 Provided by the Vienna University of Medicine
Citation: Patients with chronic liver disease experience liver complications as a result of severe COVID-19 (2022, June 15) recovered on June 15, 2022
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