Letter to the Editor: Progressive cholestasis and associated sclerosing cholangitis are complications of COVID-19 in patients with chronic liver disease

Le résumé fourni par la source

To the editor, We read the article by Hartl et al1 with great intrigue. The study concluded that 20% of patients with chronic liver disease (CLD) develop progressive cholestasis after severe acute respiratory syndrome coronavirus-2 infection and patients with NAFLD/NASH and metabolic risk factors are at particular risk for developing cholestatic liver failure and/or secondary sclerosing cholangitis after COVID-19. Although this study adds to the growing evidence that CLD patients are likely to have higher mortality rates due to severe acute respiratory syndrome coronavirus-2 infection, several points are worthy of mention. First, in this study, stratification was done according to the severity of CLD. We think that an additional stratification according to the etiology of liver disease is warranted, as many studies have demonstrated that etiology is an independent risk factor for adverse clinical outcomes. Two reviews published in 2023 describe the role of etiology in the morbidity of severe acute respiratory syndrome coronavirus-2 infection. They conclude that COVID-19 infection in alcohol-associated liver disease and NAFLD patients are most frequently associated with adverse outcomes, whereas other etiologies such as chronic viral hepatitis due to HBV do not seem to affect the prognosis of COVID-19 infection.2,3 Second, this study included only hospitalized patients, which can increase bias. Antiviral drugs, antibiotics, and corticosteroids are all used to treat hospitalized COVID-19 patients and are known to cause liver injury. The reported incidence of DILI in patients with COVID-19 is 25.4%.4 Additional analysis should have been done to control for potential confounders to strengthen the evidence. Third, this study included hospitalized COVID-19 patients between March 2020 and July 2021. Although the COVID-19 vaccine became globally available in late 2020, the vaccination status of the patients included in the study is not specified. Vaccination has resulted in decreased hospitalization and mortality rates in CLD patients. However, CLD patients are underrepresented in vaccine trials, and additional studies on their efficacy and safety in these patients need to be done.2 This study failed to provide any evidence about either the benefits or the risks in CLD patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.