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

T. Voigtländer; A. A. Negm; A. S. Schneider; C. P. Strassburg; M. P. Manns; J. Wedemeyer; T. O. Lankisch

doi:10.1055/s-0032-1325733

Endoscopy, Inhaltsverzeichnis

Endoscopy 2012; 44(11): 1055-1058
DOI: 10.1055/s-0032-1325733

Case report/series

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

T. Voigtländer

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

,

A. A. Negm

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

,

A. S. Schneider

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

,

C. P. Strassburg

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

,

M. P. Manns

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

²Integrated Research and Treatment Center – Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany

,

J. Wedemeyer^*

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

²Integrated Research and Treatment Center – Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany

,

T. O. Lankisch

¹Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

²Integrated Research and Treatment Center – Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany

› Institutsangaben

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.

Volltext

Referenzen

References
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