title: 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.
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Voigtländer
authors.forename: A A
authors.initials: AA
authors.lastname: Negm
authors.forename: A S
authors.initials: AS
authors.lastname: Schneider
authors.forename: C P
authors.initials: CP
authors.lastname: Strassburg
authors.forename: M P
authors.initials: MP
authors.lastname: Manns
authors.forename: J
authors.initials: J
authors.lastname: Wedemeyer
authors.forename: T O
authors.initials: TO
authors.lastname: Lankisch
mesh_terms: D000328:Adult; D001646:Bile / Q000382:microbiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D016638:Critical Illness; D058625:End Stage Liver Disease / Q000175:diagnosis; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index