Related Experiment Video
Updated: Sep 5, 2025
Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis
Published on: February 10, 2015
Secondary Sclerosing Cholangitis Following Coronavirus Disease 2019 (COVID-19): A Multicenter Retrospective Study
Peter Hunyady1, Lea Streller2, Darius F Rüther3
1Department of Internal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
Insights
Secondary sclerosing cholangitis following COVID-19 (COVID-SSC) is similar to that in critically ill patients (SSC-CIP). Ursodeoxycholic acid and high albumin levels improve survival, while cirrhosis worsens it.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Diseases
Background:
- Secondary sclerosing cholangitis (SSC) is a rare, severe liver disease.
- Cases of SSC have emerged after COVID-19 infection (COVID-SSC).
- This study compares COVID-SSC to SSC in critically ill patients (SSC-CIP).
Purpose of the Study:
- To compare COVID-SSC with SSC-CIP.
- To identify factors affecting transplant-free survival in SSC patients.
Main Methods:
- Retrospective, multicenter study of 127 SSC patients from 9 German tertiary care centers.
- Comparison of COVID-SSC and SSC-CIP cohorts.
- Logistic regression analysis to determine predictors of transplant-free survival.
Main Results:
- COVID-SSC and SSC-CIP patients showed similar clinical characteristics and transplant-free survival.
- Ursodeoxycholic acid (UDCA) use and high serum albumin levels were associated with improved survival.
- Liver cirrhosis was linked to a worse prognosis; MDRO infection did not impact survival.
Conclusions:
- COVID-SSC and SSC-CIP share similar clinical phenotypes and risk factors.
- UDCA shows potential as a therapeutic option for SSC.
- Further prospective trials are necessary to validate these findings.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
