Cholangiopathy in critically ill patients surviving beyond the intensive care period: a multicentre survey in liver units

Laurent, Lucie; Lemaître, Caroline; Minello, Anne; Plessier, Aurélie; Lamblin, Géraldine; Poujol-Robert, Armelle; Gervais-Hasenknopf, Anne; Pariente, Emile-Alexandre; Bélénotti, P.; Mostefa-Kara, Nassim; Sogni, Philippe; Legrand, Matthieu; Cournac, J.M.; Tamion, Fabienne; Savoye, Guillaume; Bédossa, Pierre; Valla, Dominique‐Charles; Vilgrain, Valérie; Goria, Odile

doi:10.1111/apt.14367

Cited by 26 publications

(32 citation statements)

References 16 publications

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“…This subsequently progresses to diffuse biliary stricturing and dilatations with the classic beaded appearance. 3 The main hallmark however of SSC-CIP that differentiates it from other potential diagnoses is that the extrahepatic biliary system is typically spared. 9 MRCP and/or ERCP remain the gold standard in imaging for patients with suspected SSC-CIP.…”

Section: Toxic Bilementioning

confidence: 99%

“…1 Several secondary causes have been identified over recent years, including ischaemia and iatrogenic, yet the SSC in critically ill patients (SSC-CIP) subgroup is particularly rare and was first described in 2001 by Leonhardt et al 2 The underlying pathophysiology in patients with SSC-CIP is thought to be a combination of bile duct ischaemia and changes to the composition of bile. 3 This results in cholangiocyte necrosis and formation of bile casts that obstruct the biliary system, giving rise to recurrent cholangitis. 1 The most important factor distinguishing SSC-CIP from other hepatobiliary diseases related to critically ill patients is the persistent cholestasis despite clinical recovery of other organ injuries.…”

Section: Introductionmentioning

confidence: 99%

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Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection

2020

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A previously well 59-year-old man required a prolonged intensive care unit stay due to severe COVID-19 symptoms. During the admission, he developed a cytokine storm, also known as secondary haemophagocytic lymphohistocytosis, and multiorgan failure. Despite recovering from his other organ failures, his liver function continued to deteriorate. Magnetic resonance cholangiopancreatography and subsequent endoscopic retrograde cholangiopancreatography revealed extensive intrahepatic duct dilatation with ‘beading’ but common bile duct sparing. Given the patient had no primary liver disease prior to admission, we considered secondary causes of cholestatic liver injury; this led us to an unusual diagnosis of secondary sclerosing cholangitis in critically ill patients. This case demonstrates a rare disease that has developed specifically in the context of SARS-CoV-2 infection. A review of current literature and the underlying pathophysiology for this rare disease are discussed, particularly in relation to COVID-19.

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Section: Toxic Bilementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection

2020

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“…None of the patients in the above series had immunohistochemical evidence of SARS-CoV-2 infection on liver biopsy samples. 76 …”

Section: Liver Manifestations Of Covid-19mentioning

confidence: 99%

Coronavirus Disease-2019 (COVID-19) and the Liver

Elhence¹,

Vaishnav²,

Biswas³

et al. 2021

Journal of Clinical and Translational Hepatology

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Within a year of its emergence, coronavirus disease-2019 (COVID-19) has evolved into a pandemic. What has emerged during the past 1 year is that, apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) derives its name, it presents with a myriad of gastrointestinal (GI) and liver manifestations. Expression of the angiotensinconverting enzyme-2 (ACE-2) receptor throughout the GI tract and liver, which is the receptor for the SARS-CoV-2, may be responsible for the GI and liver manifestations. Besides acting directly via the ACE-2 receptor, the virus triggers a potent immune response, which might have a role in pathogenesis. The virus leads to derangement in liver function tests in close to 50% of the patients. The impact of these derangements in patients with a normal underlying liver seems to be innocuous. Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease, leading to high mortality. Evolving data suggests that, contrary to intuition, liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality. The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered. With newer variants of COVID-19, which can spread faster than the original strain, the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.

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“…Ischemic damage of the biliary system is discussed as the main driving factor for the development of SC-CIP and was observed in liver biopsies [ 1 , 2 , 6 , 7 , 38 ]. Because of its singular supply from the hepatic artery, the biliary tree is vulnerable to hypotension [ 39 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

High Rate of Gastrointestinal Bleeding in Patients with Secondary Sclerosing Cholangitis in Critically Ill Patients (SC-CIP)

Blesl

Eibisberger

Schörghuber

et al. 2021

JCM

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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) (p = 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.

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Cholangiopathy in critically ill patients surviving beyond the intensive care period: a multicentre survey in liver units

Abstract: In patients surviving their ICU stay, ICU cholangiopathy is not uniformly fatal in the short term or clinically symptomatic in the medium term. Preservation of the distal common bile duct appears to be a finding differentiating ICU cholangiopathy from other diffuse cholangiopathies.

Cited by 26 publications

References 16 publications

Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection

Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection

Coronavirus Disease-2019 (COVID-19) and the Liver

High Rate of Gastrointestinal Bleeding in Patients with Secondary Sclerosing Cholangitis in Critically Ill Patients (SC-CIP)

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