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Chronic liver disease patients experience hepatic complications as a result of severe COVID-19

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Patients with chronic liver disease are more likely to experience liver damage as a result of poor COVID-19. A study conducted by a research team led by Lukas Hartl, Thomas Reiberger and Michael Trauner from the Department of Gastroenterology and Hematology of MedUni Vienna and the University of Vienna found that high levels of cholestasis and damage to the bile ducts, the so-called secondary . sclerosing cholangitis (SSC), develops with a surprising frequency in patients with pre-existing liver disease. SSC occurs more frequently after COVID-19 than after other serious infections. 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 from the Department of Gastroenterology and Hepatology in the III Department of Medicine of MedUni Vienna and Vienna University Hospital studied liver chemistry and 496 hospital. patients with COVID-19. Sixty-five of these patients are already present liver diseaselike fatty liver disease, cirrhosis or hepatocellular carcinoma. The focus of the study was to describe the exact nature of liver proteinuria in these patients after infection.

It was found that the increase in transaminases in early COVID-19 was frequent. These enzymes, AST (aspartate aminotransferase) and ALT.alanine aminotransferase), are considered as signs of liver damage. Later, these values ​​were corrected: issues previously described in previous studies. On the contrary, the measure of biliary congestion (cholestasis), alkaline phosphatase (AP) and GGT (gamma glutamyl transferase) are slowly elevated in many patients during infection without relapse. Of these patients, 23.1% even developed cholestatic liver failurei.e. liver failure associated with biliary stasis.

The researchers used magnetic resonance imaging (MRCP) and endoscopic (ERCP) technology to show that irreversible changes occur in the bile ducts of patients, called secondary sclerosing cholangitis (SSC) . This disease also occurs after other states of severe illness, such as lack of oxygen or severe infection. The tumor shows progress and can lead to liver transplant and even death. Fifteen percent of chronic liver disease patients with severe COVID-19 enhanced SSC. Many of these patients have previous conditions such as obesity, diabetes, obesity or high blood pressure, and sometimes months of intensive care are required because of COVID-19.

In summary, the study found that COVID-19 causes an increase in the incidence of cholestasis, liver failure, and even SSC in 15% of patients. Lukas Hartl explains: “Using data from our comparison group of ICU patients who did not have COVID-19, we were able to show that SSC was more prevalent in patients with COVID-19. 19 also do not suffer from illness in the ICU. And are usually admitted for a long time. However, very few of those affected by COVID-19 continue to develop SSC. “

The reasons 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 important, in any case, to closely monitor the value of liver function in ICU patients while or following COVID-19. Through therapeutic, endoscopy (ERCP) of bile ducts it can be used to widen the drainage and remove some water barriers, if necessary. Emergency management of appropriate anti-oxygen drugs as part of intensive care plays an important role. “Currently, there is no effective treatment for multiple sclerosing cholangitis, but according to Michael Trauner, the Department focuses on developing new therapies.

Lukas Hartl said further studies have been conducted to look at the long-term mechanism of cholestasis measurement in patients with COVID-19 associated with liver failure at the end of COVID-19 in patients with no survival. liver disease. This is because there has already been evidence that COVID-19 is associated with proliferation hanta enzymes in this group of patients as well.


A strong association was found between negative liver test and low COVID-19 results


Learn more:
Lukas Hartl et al, Progressive cholestasis and associated sclerosing cholangitis are frequent complications of COVID-19 in chronic liver disease patients, Hepatology (2022). DOI: 10.1002 / hep.32582

hintChronic hepatitis sufferers are experiencing liver problems as a result of severe COVID-19 (2022, June 15) retrieved June 15, 2022 from https://medicalxpress.com/news/2022-06-chronic-liver-disease -patients-hepatic .html

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