Secondary Sclerosing Cholangitis Following Coronavirus Disease 2019 (COVID-19): A Multicenter Retrospective Study

Peter Hunyady, Lea Streller, Darius F. Rüther, Sara Reinartz Groba, Dominik Bettinger, Daniel Fitting, Karim Hamesch, Jens U. Marquardt, Victoria T. Mücke, Fabian Finkelmeier, Asieb Sekandarzad, Tobias Wengenmayer, Ayoub Bounidane, Felicitas Weiss, Kai Henrik Peiffer, Bernhard Schlevogt, Stefan Zeuzem, Oliver Waidmann, Marcus Hollenbach, Martha M. KirsteinJohannes Kluwe, Fabian Kütting, Marcus M. Mücke*

*Corresponding author for this work
7 Citations (Scopus)


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.

Original languageEnglish
JournalClinical Infectious Diseases
Issue number3
Pages (from-to)E179-E187
Publication statusPublished - 08.02.2023

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  • Research on SARS-CoV-2 / COVID-19

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