Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness
Objective Secondary sclerosing cholangitis (SSC) represents a disease with a poor prognosis increasingly diagnosed in clinical settings. Notably, SSC in critically ill patients (SSC-CIP) is the most frequent cause. Variables associated with worse prognosis remain unclear. The primary aim of this stu...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/12/1/e001571.full |
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| author | Christoph Schramm Hartmut Schmidt Christian Gerges Alisan Kahraman Christian M Lange Jassin Rashidi-Alavijeh Katharina Willuweit Georgios Konstantis Dorsa Ghaffar Loy Moghadam Alexandra Frey Nargiz Nuruzade Moritz Passenberg |
| author_facet | Christoph Schramm Hartmut Schmidt Christian Gerges Alisan Kahraman Christian M Lange Jassin Rashidi-Alavijeh Katharina Willuweit Georgios Konstantis Dorsa Ghaffar Loy Moghadam Alexandra Frey Nargiz Nuruzade Moritz Passenberg |
| author_sort | Christoph Schramm |
| collection | DOAJ |
| description | Objective Secondary sclerosing cholangitis (SSC) represents a disease with a poor prognosis increasingly diagnosed in clinical settings. Notably, SSC in critically ill patients (SSC-CIP) is the most frequent cause. Variables associated with worse prognosis remain unclear. The primary aim of this study was to identify factors associated with transplant-free survival in SSC-CIP patients using readily available data.Methods A cohort of 47 patients diagnosed with SSC-CIP was retrospectively analysed for clinical, biochemical and endoscopic variables. Kaplan-Meier survival curves, log-rank tests and univariate Cox proportional hazards models were used to assess associations with transplant-free survival. A multivariable Cox regression model was constructed using Lasso regularisation and validated with Bootstrap resampling. Model performance was assessed using the C-statistic for discrimination.Results Kaplan-Meier analysis identified bile duct obstruction requiring stent placement, and cholangitis episodes, as significant prognostic factors. In univariable analysis, age over 47 years (HR 2.61 (95% CI 1.02, 7.06), p=0.04), at least one cholangitis episode (HR 2.46 (95% CI 1.005, 6.06), p=0.04), stent placement (HR 2.89 (95% CI 1.13, 7.38), p=0.03), lower albumin levels (HR 0.52 (95% CI 0.28, 0.97), p=0.04) and higher international normalised ratio (INR) (HR 3.22 (95% CI 1.09, 9.53), p=0.03) were significant. Multivariable analysis showed that age at diagnosis, albumin and INR were significant independent predictors. The C-index was 0.78 (95% CI 0.65, 0.91), surpassing the model of end-stage liver disease score’s prognostic accuracy (Concordance Index at 3 years: 66.2% vs 74.9%).Conclusion These findings provide valuable insights for establishing standard exception criteria for this rare liver disease, which could lead to improved organ allocation. Further prospective multicentre studies are necessary to validate our findings. |
| format | Article |
| id | doaj-art-9e8feea5b9de465cbd837e3fe1507fcc |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Gastroenterology |
| spelling | doaj-art-9e8feea5b9de465cbd837e3fe1507fcc2025-01-05T05:20:09ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742025-01-0112110.1136/bmjgast-2024-001571Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illnessChristoph Schramm0Hartmut Schmidt1Christian Gerges2Alisan Kahraman3Christian M Lange4Jassin Rashidi-Alavijeh5Katharina Willuweit6Georgios Konstantis7Dorsa Ghaffar Loy Moghadam8Alexandra Frey9Nargiz Nuruzade10Moritz Passenberg11Department of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, Max Grundig Klinik GmbH, Buhl, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, Ludwig-Maximilians-Universität München Medizinische Fakultät, Munchen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyUniversitätsklinikum Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, University of Duisburg-Essen, Essen, GermanyObjective Secondary sclerosing cholangitis (SSC) represents a disease with a poor prognosis increasingly diagnosed in clinical settings. Notably, SSC in critically ill patients (SSC-CIP) is the most frequent cause. Variables associated with worse prognosis remain unclear. The primary aim of this study was to identify factors associated with transplant-free survival in SSC-CIP patients using readily available data.Methods A cohort of 47 patients diagnosed with SSC-CIP was retrospectively analysed for clinical, biochemical and endoscopic variables. Kaplan-Meier survival curves, log-rank tests and univariate Cox proportional hazards models were used to assess associations with transplant-free survival. A multivariable Cox regression model was constructed using Lasso regularisation and validated with Bootstrap resampling. Model performance was assessed using the C-statistic for discrimination.Results Kaplan-Meier analysis identified bile duct obstruction requiring stent placement, and cholangitis episodes, as significant prognostic factors. In univariable analysis, age over 47 years (HR 2.61 (95% CI 1.02, 7.06), p=0.04), at least one cholangitis episode (HR 2.46 (95% CI 1.005, 6.06), p=0.04), stent placement (HR 2.89 (95% CI 1.13, 7.38), p=0.03), lower albumin levels (HR 0.52 (95% CI 0.28, 0.97), p=0.04) and higher international normalised ratio (INR) (HR 3.22 (95% CI 1.09, 9.53), p=0.03) were significant. Multivariable analysis showed that age at diagnosis, albumin and INR were significant independent predictors. The C-index was 0.78 (95% CI 0.65, 0.91), surpassing the model of end-stage liver disease score’s prognostic accuracy (Concordance Index at 3 years: 66.2% vs 74.9%).Conclusion These findings provide valuable insights for establishing standard exception criteria for this rare liver disease, which could lead to improved organ allocation. Further prospective multicentre studies are necessary to validate our findings.https://bmjopengastro.bmj.com/content/12/1/e001571.full |
| spellingShingle | Christoph Schramm Hartmut Schmidt Christian Gerges Alisan Kahraman Christian M Lange Jassin Rashidi-Alavijeh Katharina Willuweit Georgios Konstantis Dorsa Ghaffar Loy Moghadam Alexandra Frey Nargiz Nuruzade Moritz Passenberg Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness BMJ Open Gastroenterology |
| title | Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness |
| title_full | Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness |
| title_fullStr | Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness |
| title_full_unstemmed | Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness |
| title_short | Prognostic factors for transplant-free survival in patients with secondary sclerosing cholangitis associated with critical illness |
| title_sort | prognostic factors for transplant free survival in patients with secondary sclerosing cholangitis associated with critical illness |
| url | https://bmjopengastro.bmj.com/content/12/1/e001571.full |
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