S2659 SARS-CoV-2-Associated Cholestatic Liver Injury: A Case Series in Critically Ill Patients

Autor: Edward C Oldfield, Nicolas M. Intagliata, Anthony Rainho, Zachary Dickson, Stephen H. Caldwell
Rok vydání: 2021
Předmět:
Zdroj: American Journal of Gastroenterology. 116:S1115-S1115
ISSN: 1572-0241
0002-9270
DOI: 10.14309/01.ajg.0000784168.58228.d1
Popis: Introduction: Hepatocellular injury has been documented in 14% to 76% of patients suffering from Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is associated with increased rates of intubation and mortality. SARS-CoV-2 enters target cells by binding to angiotensin-converting enzyme 2 present in the lungs, small intestine, cholangiocytes, and hepatocytes. While most patients experience mild acute liver injury, some critically ill patients develop a prolonged cholestatic injury pathologically similar to secondary sclerosing cholangitis. Histologic assessments have demonstrated microvesicular steatosis, diffuse intrahepatic vascular thrombosis, and chronic fibrous endothelial thickening. We present five cases of cholestatic liver injury in critically ill patients, including a novel case of severe hepatic arteriopathy during endoscopic retrograde cholangiopancreatography (ERCP). Case Description/Methods: We identified 5 patients without preexisting liver disease who developed prolonged cholestatic liver injury following severe COVID-19 infection requiring mechanical ventilation, antibiotics, and prolonged hospitalization (Table 1). Four patients developed shock requiring vasopressor support and two required extracorporeal membrane oxygenation. Additionally, Patient 1 underwent ERCP which revealed friable hepatic parenchyma and vascularture that appeared angiographically similar to secondary sclerosing cholangitis. While liver chemistries were normal or mildly elevated at the time of COVID-19 diagnosis, all patients experienced significant cholestasis with predominantly elevated alkaline phosphatase levels ranging from the 900s to 4000s. In patients who survived their initial hospitalization, liver chemistries remained elevated months beyond resolution of their pulmonary and renal injuries, and none had returned to baseline as of this writing. Discussion: We described several cases of prolonged cholestasis in patients with severe COVID-19 infection without preexisting liver disease. While a component of this acute liver injury could be attributed to drugs or ischemia, the timeframe and degree of injury suggest a different etiology, which we postulate may be a combination of secondary sclerosing cholangitis and direct hepatic injury from SARS-CoV-2. Additional research and longitudinal monitoring of these patients is needed to better characterize this type of injury and determine the risk of clinically relevant, long-term liver dysfunction.
Databáze: OpenAIRE
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