November 2023 - Lukas Hartl

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Dr. Lukas Hartl, BA

MedUni Wien RESEARCHER OF THE MONTH November 2023

It is known that many patients exhibit elevated liver chemistries after infection with the severe acute coronavirus-2 (SARS-CoV-2). This cross-sectional study investigated the trajectory of liver enzymes in a cohort of 495 patients (65 of whom had preexisting liver disease). We found a biphasic pattern of liver chemistry elevation: An initial increase in transaminases (aspartate aminotransferase/alanine aminotransferase) was followed by a continuous increase in the cholestasis parameters alkaline phosphatase and gamma-glutamyl transferase. 23.1% of patients with liver disease developed laboratory signs of cholestatic liver failure and 15.4% were diagnosed with secondary sclerosing cholangitis (SSC), a progressive disease with destruction of the bile ducts. SSC was more frequent in patients with COVID-19 than in a control cohort of patients with liver disease and non-COVID-19 pneumonia, indicating a potential direct hepatotoxicity of SARS-CoV-2.

Selected Literature

1. Hartl L, Haslinger K, Angerer M, Semmler G, Schneeweiss-Gleixner M, Jachs M, Simbrunner B, et al. Progressive cholestasis and associated sclerosing cholangitis are frequent complications of COVID-19 in patients with chronic liver disease. Hepatology 2022;76:1563- 1575.

2. Hartl L, Haslinger K, Angerer M, Jachs M, Simbrunner B, Bauer DJM, Semmler G, et al. Age-adjusted mortality and predictive value of liver chemistries in a Viennese cohort of COVID- 19 patients. Liver Int 2022.

3. Horvatits T, Drolz A, Trauner M, Fuhrmann V. Liver Injury and Failure in Critical Illness. Hepatology 2019;70:2204-2215.

4. Nardo AD, Schneeweiss-Gleixner M, Bakail M, Dixon ED, Lax SF, Trauner M. Pathophysiological mechanisms of liver injury in COVID-19. Liver Int 2021;41:20-32.

5. Hartl L, Jachs M, Desbalmes C, Schaufler D, Simbrunner B, Paternostro R, Schwabl P, et al. The differential activation of cardiovascular hormones across distinct stages of portal hypertension predicts clinical outcomes. Hepatol Int 2021.

6. Hartl L, Jachs M, Simbrunner B, Bauer DJM, Semmler G, Gompelmann D, Szekeres T, et al. Cirrhosis-Associated RAS-Inflammation-Coagulation Axis Anomalies: Parallels to Severe COVID-19. J Pers Med 2021;11.

7. Jachs M, Hartl L, Simbrunner B, Bauer D, Paternostro R, Scheiner B, Balcar L, et al. The Sequential Application of Baveno VII Criteria and VITRO Score Improves Diagnosis of Clinically Significant Portal Hypertension. Clin Gastroenterol Hepatol 2022.

8. Hartl L, Semmler G, Hofer BS, Schirwani N, Jachs M, Simbrunner B, Bauer DJM, et al. COVID-19-related downscaling of in-hospital liver care decreased patient satisfaction and increased liver-related mortality. Hepatology Comm 2021.

9. Hartl L, Jachs M, Bauer D, Simbrunner B, Chromy D, Binter T, Steininger L, et al. HCV hotline facilitates Hepatitis C elimination during the COVID-19 pandemic. J Viral Hepat 2022;29:1062-1072.

10. Hartl L, Tatscher E, Weiss M, Balcar L, Strassl R, Jachs M, Mandorfer M, et al. The impact of COVID-19 on liver transplantation programs in Austria. Wien Klin Wochenschr 2022;134:875-882.