Cholangiopathy after severe COVID-19 may lead to liver injury, failure
For patients with severe COVID-19, cholangiopathy was a late complication with potential for progressive biliary injury or liver failure, according to a study published in the American Journal of Gastroenterology.
“COVID-19 cholangiopathy must be considered in patients who have experienced severe COVID-19 illness and are found to have persistently elevated liver tests with a cholestatic pattern,” Ira M. Jacobson, MD, professor of medicine, director of hepatology, New York University Grossman School of Medicine told Healio Gastroenterology. “[Magnetic resonance cholangiopancreatography (MRCP)] demonstrates features resembling those of sclerosing cholangitis. Progressive biliary tract injury associated with deteriorating liver function may ensue in the months following hospital discharge, culminating in liver transplantation required in one of our patients, and a few others recently reported in the literature, within a year of COVID-19 illness. The pathogenesis of this syndrome may involve factors similar to those suggested to underlie secondary sclerosing cholangitis of critical illness, including ischemic biliary injury and cytokine storm, but a possible role for viral infection of cholangiocytes should be explored further.”
From March 1, 2020, to August 15, 2020, Jacobson and colleagues performed a retrospective study of 12 COVID-19 patients for whom hepatology service was consulted for abnormal liver tests. Patients’ mean age was 58 years; 11 were men.
“Bile duct injury was identified by abnormal liver tests with serum [alkaline phosphatase (ALP)] [more than three times] upper limit of normal and abnormal findings on magnetic resonance cholangiopancreatography,” the researchers wrote.
Investigators recorded clinical, laboratory, radiological and histological findings.
Jacobson and colleagues reported the mean time from COVID-19 diagnosis to cholangiopathy diagnosis was 118 days; peak median serum alanine aminotransferase was 661 U/L; and the peak median serum ALP was 1,855 U/L. Among these patients, marked elevations of erythrocyte sedimentation rate, C-reactive protein and D-dimers were common, researchers noted.
“Magnetic resonance cholangiopancreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%),” Jacobson and colleagues wrote.
According to researchers, acute and/or chronic large duct obstruction without clear bile duct loss was observed in liver biopsy in four patients. Investigators showed radiographic evidence of progressive biliary tract damage. After five patients experienced persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis, they were referred for consideration of liver transplantation. Jacobson and colleagues noted one patient underwent a liver donor liver transplantation.