title: Sepsis-associated cholestasis in adult patients: a prospective study.
abstract: BACKGROUND
  Sepsis-associated cholestasis is a common problem in neonatal patients. However, there are limited data related to sepsis-associated cholestasis in adults. In this study, the authors assessed the clinical characteristics, risk factors and outcome of adult patients with sepsis-associated cholestasis.
  
  
  METHODS
  An observational prospective single-center study was conducted. A total of 608 patients with sepsis (66 patients with cholestasis and 542 without evidence of cholestasis) from January 1, 2005, to December 31, 2011, were included from the infectious disease unit. Demographic, clinical and laboratory information were recorded on admission for all patients. Additional data were also collected on the day of the 1st episode of bacteremia for patients who developed cholestasis. Accordingly, the organ dysfunction scores (Acute Physiology and Chronic Health Evaluation [APACHE] II and Sequential Organ Failure Assessment [SOFA]) were assessed on the same day.
  
  
  RESULTS
  The mean age of the 608 patients was 49.3 ± 11.4 years (range, 22-83 years); 312 (51.3%) patients were men, 296 (48.7%) were women. The mean APACHE II and SOFA score were 15.2 ± 6 and 5.6 ± 2.3, respectively. Sepsis-associated cholestasis was strongly associated with older age, biomarkers of organ dysfunction and clinical composite scores (APACHE II and SOFA). Mortality was higher in patients with sepsis-associated cholestasis (10.6%) compared with subjects with sepsis without cholestasis (1.5%) (P < 0.05).
  
  
  CONCLUSIONS
  The authors found that sepsis-associated cholestasis affects the outcome of patients with sepsis in the infectious disease unit. Additional clinical studies are necessary to elucidate the pathology and pathophysiology of sepsis-associated cholestasis.
authors.affiliation: Department of Infectious Disease (H-BF, A-SC, ZL, L-TX, X-JM, HZ, Z-FT, J-JW, F-MY), The People's Liberation Army 161 Hospital, Wuhan, Hubei Province, China; and Department of Infectious Diseases, (D-LY), Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
authors.forename: He-Bin
authors.initials: HB
authors.lastname: Fan
authors.forename: Dong-Liang
authors.initials: DL
authors.lastname: Yang
authors.forename: An-Shen
authors.initials: AS
authors.lastname: Chen
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.forename: Li-Tong
authors.initials: LT
authors.lastname: Xu
authors.forename: Xiao-Ju
authors.initials: XJ
authors.lastname: Ma
authors.forename: Hao
authors.initials: H
authors.lastname: Zhou
authors.forename: Zhan-Fei
authors.initials: ZF
authors.lastname: Tian
authors.forename: Juan-Juan
authors.initials: JJ
authors.lastname: Wu
authors.forename: Fu-Ming
authors.initials: FM
authors.lastname: Yan
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China / Q000453:epidemiology; D002779:Cholestasis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality