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. 2012 Dec 22;17(1):30.
doi: 10.1186/2047-783X-17-30.

Abdominal obesity and prolonged prone positioning increase risk of developing sclerosing cholangitis in critically ill patients with influenza A-associated ARDS

Thomas Weig  1 , Mirjam I Schubert, Norbert Gruener, Michael E Dolch, Lorenz Frey, Jens Miller, Thorsten Johnson, Michael Irlbeck
Affiliations

Abdominal obesity and prolonged prone positioning increase risk of developing sclerosing cholangitis in critically ill patients with influenza A-associated ARDS

Thomas Weig et al. Eur J Med Res. .

Abstract

Background: Secondary sclerosing cholangitis is a severe disease of the biliary tract. Over the last decade, several cases of sclerosing cholangitis in critically ill patients (SC-CIP) were reported. Reports in the literature so far are characterized by a wide variety of underlying causes of critical illness, thereby hindering a risk-factor analysis. We report on a homogenous cohort of critically ill patients with influenza A (H1N1) pneumonia and severe acute respiratory distress syndrome (ARDS), of whom a subgroup developed sclerosing cholangitis, allowing for probing of risk factors associated with SC-CIP.

Methods: Twenty-one patients (5 female, 16 male, 46.3 ± 10.8 years) with severe ARDS due to H1N1 pneumonia were retrospectively divided into two groups, characterized by the presence (n = 5) and absence of SC-CIP (n = 16). A large array of clinical data, laboratory parameters, and multi-detector computed tomography-derived measures were compared.

Results: Both patient groups showed severe pulmonary impairment. Severity of disease on admission day and during the first 14 days of treatment showed no difference. The patients developing SC-CIP had a higher body mass index (BMI) (37.4 ± 6.0 kg/m(2) vs. 29.3 ± 6.8 kg/m(2); P = 0.029) and a higher volume of intraperitoneal fat (8273 ± 3659 cm(3) vs. 5131 ± 2268 cm(3); P = 0.033) and spent a longer cumulative period in the prone position during the first 14 days (165 ± 117 h vs. 78 ± 61 h; P = 0.038).

Conclusion: Our results suggest that obesity, intraperitoneal fat volume, and a longer cumulative duration spent in the prone position may put patients with ARDS at risk of developing SC-CIP. These results lead us to propose that the prone position should be carefully deployed, particularly in abdominally obese patients, and that frequent checks be made for early hepatic dysfunction.

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Figures

Figure 1
Figure 1
Cumulative time of pronation in patients without (nSSC) and with (SSC) secondary cholangitis. * indicates significant difference (P = 0.04).
Figure 2
Figure 2
Ventilator settings and respiratory function indicated by peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP) and ratio of partial arterial oxygen pressure to the fraction of inspired oxygen (PaO2/FiO2). * indicates significant difference (P < 0.001).
Figure 3
Figure 3
Temporal course of alkaline phosphatase (AP), γ-glutamyl transpeptidase (GGT) and total serum bilirubin levels in patients without (nSSC) and with (SSC) secondary cholangitis. * indicates significant difference (P = 0.001).
See this image and copyright information in PMC

References

    1. Ruemmele P, Hofstaedter F, Gelbmann CM. Secondary sclerosing cholangitis. Nat Rev Gastroenterol Hepatol. 2009;6(5):287–295. doi: 10.1038/nrgastro.2009.46. - DOI - PubMed
    1. Gelbmann CM, Rummele P, Wimmer M, Hofstadter F, Gohlmann B, Endlicher E, Kullmann F, Langgartner J, Scholmerich J. Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients. Am J Gastroenterol. 2007;102(6):1221–1229. doi: 10.1111/j.1572-0241.2007.01118.x. - DOI - PubMed
    1. Kirchner GI, Scherer MN, Obed A, Ruemmele P, Wiest R, Froh M, Loss M, Schlitt HJ, Scholmerich J, Gelbmann CM. Outcome of patients with ischemic-like cholangiopathy with secondary sclerosing cholangitis after liver transplantation. Scand J Gastroenterol. 2011;46(4):471–478. doi: 10.3109/00365521.2010.537683. - DOI - PubMed
    1. Benninger J, Grobholz R, Oeztuerk Y, Antoni CH, Hahn EG, Singer MV, Strauss R. Sclerosing cholangitis following severe trauma: description of a remarkable disease entity with emphasis on possible pathophysiologic mechanisms. World J Gastroenterol. 2005;11(27):4199–4205. - PMC - PubMed
    1. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–2963. doi: 10.1001/jama.1993.03510240069035. - DOI - PubMed

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