Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-12-01

AUTHORS

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

ABSTRACT

IntroductionIn 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.MethodsTemporality, 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.ResultsSixteen 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.ConclusionsIn 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. More... »

PAGES

131

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URI

http://scigraph.springernature.com/pub.10.1186/s13054-015-0861-5

DOI

http://dx.doi.org/10.1186/s13054-015-0861-5

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https://app.dimensions.ai/details/publication/pub.1053337099

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25886728


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37 ConclusionsIn
38 IntroductionIn recent years
39 ResultsSixteen patients
40 SSC-CIP
41 University Hospital Charité
42 amount
43 arterial blood pressure
44 association
45 bile duct
46 biological plausibility
47 blood pressure
48 blood supply
49 blood transfusion
50 care treatment
51 case series
52 cases
53 causality
54 cholangitis
55 cholestasis
56 colloids
57 consistency
58 context
59 course
60 critical effect
61 decrease
62 development
63 diagnosis
64 differential diagnosis
65 disease entity
66 disturbances
67 duct
68 early development
69 effect
70 entities
71 episodes
72 essential prerequisite
73 factors
74 haemodynamic instability
75 hypotension
76 ill patients
77 individual triggers
78 inflammatory response syndrome
79 influence
80 initial need
81 instability
82 intensive care treatment
83 investigation
84 issues
85 large amount
86 large case series
87 liver transplantation
88 mean arterial blood pressure
89 mechanism
90 microcirculatory disturbances
91 mmHg
92 need
93 occurrence
94 pathogenesis
95 patients
96 plausibility
97 possible trigger factors
98 possible trigger mechanism
99 possible triggers
100 prerequisite
101 pressure
102 prevalence
103 purpose
104 recent years
105 response syndrome
106 risk factors
107 scientific context
108 separate disease entity
109 series
110 severe hypotension
111 significant step
112 step
113 study
114 supply
115 syndrome
116 systematic investigation
117 systemic inflammatory response syndrome
118 temporality
119 transfusion
120 transplantation
121 treatment
122 trigger factors
123 trigger mechanism
124 triggers
125 years
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