Blesl Andreas, Eibisberger Martin, Schörghuber Michael, Klivinyi Christoph, Stadlbauer Vanessa
Department of Internal Medicine, Division for Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria.
Department of Radiology, Medical University of Graz, 8036 Graz, Austria.
J Clin Med. 2021 Apr 29;10(9):1925. doi: 10.3390/jcm10091925.
Secondary sclerosing cholangitis in critically ill patients (SC-CIP) is a rare cholestatic liver disease triggered by long-term intensive care treatment. The aim of this study was to evaluate the frequency and characteristics of gastrointestinal bleeding in SC-CIP. Patients with diagnosed SC-CIP were retrospectively identified and compared to a control group of patients with cardiac surgery and intensive care treatment but without the development of SC-CIP. Fifty-three patients with SC-CIP and 19 controls were included in the study. The frequency of gastrointestinal bleeding was 30% in SC-CIP (16 patients) and 5% in the control group (1 patient) ( = 0.03). Bleeding occured in the mean 13 months after admission to an intensive care unit in SC-CIP, three patients (19%) suffered bleeding during intensive care treatment. Three SC-CIP patients (19%) had cirrhosis at the time of bleeding, five (31%) had splenomegaly, and four (25%) received oral anticoagulation. In SC-CIP, 13 bleedings were identified in the upper gastrointestinal tract, two in the lower, and one remained unknown. The most common reasons for bleeding were gastroduodenal ulcers. In total, 80% of patients needed blood units, and one death due to bleeding occurred in SC-CIP. In conclusion, gastrointestinal bleeding is a frequent complication in patients with SC-CIP. Whether the liver disease itself or cofactors cause the susceptibility for bleeding remains unclear.
危重症患者继发性硬化性胆管炎（SC-CIP）是一种由长期重症监护治疗引发的罕见胆汁淤积性肝病。本研究旨在评估SC-CIP患者胃肠道出血的发生率及特征。对确诊为SC-CIP的患者进行回顾性识别，并与接受心脏手术和重症监护治疗但未发生SC-CIP的对照组患者进行比较。本研究纳入了53例SC-CIP患者和19例对照。SC-CIP患者胃肠道出血发生率为30%（16例患者），对照组为5%（1例患者）（P = 0.03）。SC-CIP患者在入住重症监护病房后平均13个月发生出血，3例患者（19%）在重症监护治疗期间出血。3例SC-CIP患者（19%）在出血时患有肝硬化，5例（31%）有脾肿大，4例（25%）接受口服抗凝治疗。在SC-CIP患者中，13例出血发生在上消化道，2例在下消化道，1例出血部位不明。出血的最常见原因是胃十二指肠溃疡。总体而言，80%的患者需要输血，SC-CIP患者中有1例因出血死亡。总之，胃肠道出血是SC-CIP患者常见的并发症。尚不清楚是肝病本身还是其他因素导致出血易感性。
