{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:00:07Z","timestamp":1787666407626,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,7,4]],"date-time":"2021-07-04T00:00:00Z","timestamp":1625356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Little is known about cholestasis, including its most severe variant secondary sclerosing cholangitis (SSC), in critically ill patients with coronavirus disease 19 (COVID\u201019). In this study, we analysed the occurrence of cholestatic liver injury and SSC, including clinical, serological, radiological and histopathological findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective single\u2010centre analysis of all consecutive patients admitted to the intensive care unit (ICU) as a result of severe COVID\u201019 at the University Hospital Zurich to describe cholestatic injury in these patients. The findings were compared to a retrospective cohort of patients with severe influenza A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 34 patients with severe COVID\u201019 admitted to the ICU were included. Of these, 14 patients (41%) had no cholestasis (group 0), 11 patients (32%, group 1) developed mild and 9 patients (27%, group 2) severe cholestasis. Patients in group 2 had a more complicated disease course indicated by significantly longer ICU stay (median 51\u00a0days, IQR 25\u201086.5) than the other groups (group 0: median 9.5\u00a0days, IQR 3.8\u201018.3, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001; and group 1: median 16\u00a0days, IQR 8\u201030, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05 respectively). Four patients in group 2 developed SSC compared to none in the influenza A cohort. The available histopathological findings suggest an ischaemic damage to the perihilar bile ducts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The development of SSC represents an important complication of critically ill COVID\u201019 patients and needs to be considered in the diagnostic work up in prolonged cholestasis. The occurrence of SSC is of interest in the ongoing pandemic since it is associated with considerable morbidity and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14971","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T07:36:11Z","timestamp":1621582571000},"page":"2404-2417","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Secondary sclerosing cholangitis as cause of persistent jaundice in patients with severe COVID\u201019"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9759-122X","authenticated-orcid":false,"given":"Simon","family":"B\u00fctikofer","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Lenggenhager","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro D.","family":"Wendel Garcia","sequence":"additional","affiliation":[{"name":"Institute of Intensive Care University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewerton M.","family":"Maggio","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Haberecker","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e4cilia S.","family":"Reiner","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Br\u00fcllmann","sequence":"additional","affiliation":[{"name":"Institute of Intensive Care University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp K.","family":"Buehler","sequence":"additional","affiliation":[{"name":"Institute of Intensive Care University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Gubler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beat","family":"M\u00fcllhaupt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"J\u00fcngst","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Morell","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","unstructured":"WHO.Coronavirus disease 2019 (COVID\u201019) situation report. 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