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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients

Authors: Silke Leonhardt, Wilfried Veltzke-Schlieker, Andreas Adler, Eckart Schott, Roland Hetzer, Walter Schaffartzik, Michael Tryba, Peter Neuhaus, Daniel Seehofer

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

In recent years the development of secondary sclerosing cholangitis in critically ill patients (SSC-CIP) has increasingly been perceived as a separate disease entity. About possible trigger mechanisms of SSC-CIP has been speculated, systematic investigations on this issue are still lacking. The purpose of this study was to evaluate the prevalence and influence of promoting factors.

Methods

Temporality, consistency and biological plausibility are essential prerequisites for causality. In this study, we investigated the temporality and consistency of possible triggers of SSC-CIP in a large case series. Biological plausibility of the individual triggers is discussed in a scientific context. SSC-CIP cases were recruited retrospectively from 2633 patients who underwent or were scheduled for liver transplantation at the University Hospital Charité, Berlin. All patients who developed secondary sclerosing cholangitis in association with intensive care treatment were included. Possible trigger factors during the course of the initial intensive care treatment were recorded.

Results

Sixteen patients (68% males, mean age 45.87 ± 14.64 years) with a confirmed diagnosis of SSC-CIP were identified. Of the 19 risk factors investigated, particularly severe hypotension with a prolonged decrease in mean arterial blood pressure (MAP) to <65 mmHg and systemic inflammatory response syndrome (SIRS) were established as possible triggers of SSC-CIP. The occurrence of severe hypotension appears to be the first and most significant step in the pathogenesis. It seems that severe hypotension has a critical effect on the blood supply of bile ducts when it occurs together with additional microcirculatory disturbances.

Conclusions

In critically ill patients with newly acquired cholestasis the differential diagnosis of SSC-CIP should be considered when they have had an episode of haemodynamic instability with a prolonged decrease in MAP, initial need for large amounts of blood transfusions or colloids, and early development of a SIRS.
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Metadata
Title
Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients
Authors
Silke Leonhardt
Wilfried Veltzke-Schlieker
Andreas Adler
Eckart Schott
Roland Hetzer
Walter Schaffartzik
Michael Tryba
Peter Neuhaus
Daniel Seehofer
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0861-5

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