COVID-Associated Cast-Forming Cholangiopathy: A Commentary on Disease Mechanism, Treatment, and Prognosis

Yara Sarkis; Nasir Saleem; Raj Vuppalanchi; Mark Gromski

doi:10.2147/HMER.S384176

COVID-Associated Cast-Forming Cholangiopathy: A Commentary on Disease Mechanism, Treatment, and Prognosis

Hepat Med. 2023 Mar 28:15:27-32. doi: 10.2147/HMER.S384176. eCollection 2023.

Authors

Yara Sarkis¹, Nasir Saleem², Raj Vuppalanchi², Mark Gromski²

Affiliations

¹ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
² Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

The complete impact of COVID-19 infection continues to develop since the onset of the COVID-19 pandemic. COVID-19 cholangiopathy has been recently described in a subset of patients who recovered from severe COVID-19 infection. The most common phenotype of patients suffering from COVID-19 cholangiopathy had severe infection requiring a stay in the intensive care unit, mechanical ventilation and vasopressor medications. Patients with COVID-cholangiopathy present with severe and prolonged cholestatic liver injury. In cases where biliary cast formation is identified, we defined the entity as "COVID-19 cast-forming cholangiopathy". This subset of COVID-19 cholangiopathy is not well understood and there are no standardized diagnosis or management to this date. The reported clinical outcomes are variable, from resolution of symptoms and liver test abnormalities to liver transplant and death. In this commentary, we discuss the proposed pathophysiology, diagnosis, management, and prognosis of this disease.

Keywords: COVID-19 cholangiopathy; COVID-19 infection; cast-forming cholangiopathy; long COVID syndrome.