Open AccessSecondary sclerosing cholangitis in critically ill patients has a poor outcome but lower tumour incidence than primary sclerosing cholangitis
Author(s) -
Kirstein Martha M,
Book Thorsten,
Manns Michael P,
Hahn Thomas,
Voigtländer Torsten
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620924274
Subject(s) - medicine , hazard ratio , primary sclerosing cholangitis , gastroenterology , incidence (geometry) , confidence interval , liver transplantation , proportional hazards model , retrospective cohort study , transplantation , disease , physics , optics
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.