Secondary sclerosing cholangitis in critically ill patients has a poor outcome but lower tumour incidence than primary sclerosing cholangitis

Martha M. Kirstein, Thorsten Book, Michael P. Manns, Thomas von Hahn, Torsten Voigtländer*

*Corresponding author for this work
1 Citation (Scopus)

Abstract

Background: Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is an emerging disease with grim prognosis. Objective: Our aim was the analysis of prognostic factors, long-term outcome and risk of tumour development in SSC-CIP compared with primary sclerosing cholangitis (PSC) patients. Methods: Retrospective analysis between 2008 and 2018. Results: One hundred and eleven patients with SSC-CIP and 408 PSC patients were identified. Median orthotopic liver transplantation (OLT)-free survival was 16 months for SSC-CIP and 147 months for PSC (p < 0.001). OLT was performed in 18/111 SSC-CIP compared with 166/408 PSC patients (p < 0.001). Malignant tumours were detected in 17.9% of PSC patients (73/408) compared with 2.7% (3/111) in SSC-CIP (p < 0.001). In multivariate Cox regression analysis low levels of C-reactive protein (hazard ratio 4.687 (95% confidence interval (CI) 1.144–19.199, p = 0.032) were significantly associated with a prolonged survival whereas higher age (hazard ratio 0.488 (95% CI 0.23–1.038), p = 0.062) showed a trend for shorter survival in SSC-CIP. For PSC malignancies (hazard ratio 0.42 (95% CI 0.313–0.575), p < 0.001) and higher age (hazard ratio 0.709 (95% CI 0.544–0.922), p = 0.01) were associated with a shorter OLT-free survival. Conclusion: SSC-CIP is characterized by acute onset of liver disease and poor prognosis but with lower tumour incidence compared with PSC.

Original languageEnglish
JournalUnited European Gastroenterology Journal
Volume8
Issue number6
Pages (from-to)716-724
Number of pages9
ISSN2050-6406
DOIs
Publication statusPublished - 01.07.2020

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