Gastrointestinal Bleedings are common adverse events in Secondary Sclerosing Cholangitis in Critically Ill Patients (SC-CIP)

Background and aims The rare cholestatic liver disease secondary sclerosing cholangitis in critically ill patients (SC-CIP) is induced by long-term intensive care treatment with invasive ventilation in patients without prior liver damage. The aim of this retrospective, single-center, investigator-initiated study was to describe the frequency and characteristics of gastrointestinal bleedings in SC-CIP.

Methods Patients with the established diagnosis SC-CIP were identified retrospectively and compared to a prospectively recruited control group of patients with the need for cardiac surgery and subsequent intensive care treatment who did not develop the liver disease. The patient records were screened for gastrointestinal bleedings. Vascular anatomy of SC-CIP patients was assessed with available cross-sectional imaging modalities.

Results Fifty-three patients with SC-CIP and 19 controls were identified for the study. Gastrointestinal bleedings occurred with a frequency of 30 % in SC-CIP (16 patients) and 5 % in the control group (1 patient) (p = 0.03). Bleeding onset was in the mean more than a year after admission to an intensive care unit in SC-CIP and only three bleeding episodes emerged during the initial intensive care treatment. Three SC-CIP patients (19 %) had cirrhosis at time of bleeding, 5 (31 %) had splenomegaly and 4 (25 %) received oral anticoagulation. In SC-CIP, 13 bleedings were notified in the upper gastrointestinal tract, two in the lower, and one remained unexplained. Gastroduodenal ulcers, partly at atypical locations in the stomach, were the most common reasons for bleeding. 80 % of patients needed blood units, one death due to bleeding occurred in a patient with SC-CIP-induced cirrhosis. Altered vascular anatomy or suspected vascular stenosis was observed with similar frequency in SC-CIP patients with and without bleedings.

Conclusion In conclusion, gastrointestinal bleedings are common adverse events in patients with SC-CIP. Whether the liver disease itself or co-factors cause the susceptibility for bleeding remains unclear.

Publication History

Article published online:
01 September 2021