Presence of cholestasis and its impact on survival in SARS-CoV-2 associated acute respiratory distress syndrome.
Mathias Schneeweiss-Gleixner, Katharina Krenn, Mathias Petter, Patrick Haselwanter, Felix Kraft, Lukas Adam, Georg Semmler, Lukas Hartl, Emina Halilbasic, Nina Buchtele, Christoph Krall, Thomas Staudinger, Christian Zauner, Michael Trauner, Albert Friedrich Stättermayer
Scientific reports October 8, 2024 DOI: 10.1038/s41598-024-73948-x via PubMed
Summary
AI-generated from the abstractAmong critically ill COVID-19 patients with acute respiratory distress syndrome, more than half developed cholestasis—a liver condition marked by elevated alkaline phosphatase. Cholestasis was linked to use of extracorporeal membrane oxygenation, ketamine, high inflammation, and greater disease severity. Patients with cholestasis had worse survival in the ICU and at six months, indicating it is a negative prognostic marker.
Study at a glance
| Characteristics | Retrospective exploratory study Peer reviewed |
|---|---|
| Sample size | 225 |
| Population | Critically ill COVID-19 patients with ARDS admitted to an ICU |
| Topics | Ketamine |
| Keywords | Cholestasis Icu Liver injury Covid-19 complications |
| Citations | 3 |
| Key finding | Cholestasis developed in 53% of critically ill COVID-19 patients and was independently associated with worse ICU and six-month survival. |
Abstract
Data on cholestasis and biliary injury in patients with COVID-19 are scarce. The primary aim of this study was to evaluate the prevalence of cholestasis and factors associated with its development and outcome in critically ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS). In this retrospective exploratory study, COVID-19 patients with ARDS admitted to an intensive care unit (ICU) at the Medical University of Vienna were evaluated for the development of cholestasis defined as an alkaline phosphatase level of 1.67x upper limit of normal for at least three consecutive days. Simple and multiple logistic regression analysis was used to evaluate parameters associated with development of cholestasis and survival. Of 225 included patients 119 (53%) developed cholestasis during ICU stay. Patients with cholestasis had higher peak levels of alkaline phosphatase, gamma-glutamyl transferase, bilirubin and inflammation parameters. Factors independently associated with cholestasis were extracorporeal membrane oxygenation support, ketamine use, high levels of inflammation parameters and disease severity. Presence of cholestasis and peak ALP levels were independently associated with worse ICU and 6-month survival. Development of cholestasis is a common complication in critically ill COVID-19 patients and represents a negative prognostic marker for survival. It is associated with disease severity and specific treatment modalities of intensive care.