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Sclerosing cholangitis in critically ill patients: an important and easily ignored problem based on a German experience

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Abstract

Intensive care unit (ICU) is important in the rehabilitation of critically ill patients. In the past decades, many patients who received aggressive treatment in ICU developed sclerosing cholangitis in multiple centers. Sclerosing cholangitis in critically ill patients (SC-CIP) is a relatively new issue. To investigate the causes, clinical manifestation, treatment, and prognosis of SC-CIP, we searched for published cases in the databases of PubMed, Highwire, and Elsevier from 2001 to 2012. Data were extracted using a standard form and retrospectively analyzed. Twelve eligible studies covering 88 patients, with 64 men and 24 women, were enrolled in this analysis. The mean age was 49.8 years. All of the patients recovered from critical illnesses, such as trauma, infection, burn, and major surgeries. High pressure positive end-expiratory pressure (PEEP, peak level at 12.8 cm H2O) was utilized for all patients, with the average duration of 36.3 d. In addition, vasopressor agents were administered in approximately 60%of SC-CIP. A rapid increase in cholestasis and irregular strictures in the intrahepatic bile ducts was observed in the following months. With an average follow-up period of 17.9 months, poor outcomes were observed in 54 patients, including 34 deaths. In conclusion, ischemic injury of the biliary tree, which may be affected by PEEP and/or vasopressor administration, affects cholangiopathic procedure. As a newly discovered type of secondary sclerosing cholangitis, SC-CIP is a severe progressive complication of patients in ICU and should be carefully monitored by clinicians.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Xi’an Jiaotong University, Xi’an, 710061, China

    Ting Lin, Kai Qu, Xinsen Xu, Min Tian, Jie Gao, Chun Zhang, Ying Di & Chang Liu

  2. Surgical Intensive Care Unit, Xi’an Jiaotong University, Xi’an, 710061, China

    Ting Lin, Min Tian, Jie Gao, Chun Zhang, Ying Di & Chang Liu

  3. Department of Imaging, the First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an, 710061, China

    Yuelang Zhang

Authors
  1. Ting Lin
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  2. Kai Qu
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  3. Xinsen Xu
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  4. Min Tian
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  5. Jie Gao
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  6. Chun Zhang
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  7. Ying Di
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  8. Yuelang Zhang
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  9. Chang Liu
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Corresponding author

Correspondence to Chang Liu.

Additional information

Kai Qu and Ting Lin contributed equally to this study.

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Lin, T., Qu, K., Xu, X. et al. Sclerosing cholangitis in critically ill patients: an important and easily ignored problem based on a German experience. Front. Med. 8, 118–126 (2014). https://doi.org/10.1007/s11684-014-0306-6

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  • DOI: https://doi.org/10.1007/s11684-014-0306-6

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