Secondary sclerosing cholangitis in critically ill patients: Model of End-Stage Liver Disease score and renal function predict outcome

Abstract

Secondary sclerosing cholangitis in critically ill patients (SSC - CIP) is an underdiagnosed emerging disease. The aim of this study was to characterize clinical features and prognostic factors for mortality in SSC - CIP. This retrospective study included 54 patients who were diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) after cardiothoracic surgery (n = 21), sepsis (n = 13), polytrauma (n = 11), and others (n = 9). In total, 33 patients who either died (n = 27) or needed liver transplantation (n = 6) were compared with surviving patients (n = 21). The model for end-stage liver disease (MELD) score and need for renal replacement therapy were independent risk factors for mortality. Compared with ERCP, accuracy was 30% for ultrasound and 36 % for liver biopsies. As a result of microbiological bile analysis, 28 % of patients required a change in antibiotic treatment. SSC - CIP is frequently a fatal disease. ERCP should be considered in selected patients to establish the diagnosis and hence provide useful clinical information.

Secondary Sclerosing Cholangitis in Critically Ill Patients

“…With mortality rates of up to 50%, SSC-CIP represents a challenge to gastroenterologists and intensive care specialists. 5 Currently, SSC-CIP is still widely underdiagnosed. Early detection of the disease and its complications is crucial to improving the poor prognosis.…”

“…2–5 All of our patients had a history of intensive care treatment for a life-threatening event. Although this event often necessitates lengthy intensive care treatment, long-term treatment (>7 days) is not required for the destruction of the bile ducts, as previously believed.…”

“…Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is most likely caused by severe arterial hypotension/shock. 1–5 SSC-CIP is a progressive cholestatic liver disease characterized by necrosis of the bile duct epithelium, which leads to the rapid destruction of the visible intrahepatic bile ducts. The disease runs a chronic, irreversible course and can only be cured by liver transplantation.…”

Secondary sclerosing cholangitis in critically ill patients: current perspectives

“…Compared with ERCP, the accuracy for diagnosing SSC-CIP was 30% for ultrasound and 36% for liver biopsies 20. In recent years, magnetic resonance cholangiopancreatography (MRCP) has been increasingly utilized as a diagnostic instrument and is preferred, prior to an ERCP, since it is noninvasive imaging and these are critically ill patient at risk when undergoing any invasive procedure 24.…”

“…The outcome of patients with SSC-CIP is often liver cirrhosis and hepatic failure with high mortality rate 20,42. However, other complications can arise during the disease process that must be taken into consideration as some of these are treatable.…”