# Secondary sclerosing cholangitis in patients suffering cardiogenic shock

## TL;DR

This study finds that secondary sclerosing cholangitis is a rare but severe complication in patients with cardiogenic shock, with high mortality and limited treatment options.

## Contribution

The paper provides the first multicenter analysis of secondary sclerosing cholangitis in cardiogenic shock patients, highlighting its clinical features and outcomes.

## Key findings

- SSC-CIP prevalence in cardiogenic shock patients was 0.14%.
- In-hospital mortality was 57.1%, with high 1- and 3-year mortality rates.
- Liver transplantation was the only long-term treatment option for two patients.

## Abstract

Cardiogenic shock (CS) patients suffer from severe organ hypoperfusion, yet the incidence of secondary sclerosing cholangitis in critically ill patients (SSC‐CIP) in CS is poorly described. Given the limited evidence and severity of this syndrome, we aimed to further investigate SSC‐CIP in the context of CS.

24 251 total CS patients admitted between 1 January 2010 and 31 December 2023 were retrospectively screened for the diagnosis of SSC‐CIP across nine German tertiary care centers. Following identification of confirmed SSC‐CIP diagnosis, baseline characteristics, laboratory values, SSC‐CIP‐specific imaging, diagnostics, and outcomes were obtained for analysis. 35 CS patients with a diagnosis of SSC‐CIP were identified, representing a prevalence of 0.14% [95% confidence interval (CI) 0.10, 0.19]. Patients were predominantly male (77.1%) with a median age of 58 years (interquartile range [IQR] 52.5, 68.0). Acute myocardial infarction (42.9%) was the most common aetiology of CS, followed by cardiac arrhythmias (20.0%). Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 77.1% of cases after a median of 33 days following CS onset [IQR 24, 65], showing typical biliary casts (60.0%), intraductal filling defects (28.6%), and bile duct obliteration (20.0%). Cast removal and stent placement was performed in nearly half of ERCP procedures (45.7%). Magnetic resonance cholangiopancreatography (MRCP) was performed in 22.9% of cases and showed intraductal dilation (11.4%), lumen narrowing (17.1%), or strictures (14.3%). Median intensive care unit and hospital length of stay was 43 days [IQR 33, 66] and 58 days [IQR 33, 88], respectively. In‐hospital mortality was 57.1%. One‐year (65.7%) and 3‐year (71.4%) mortality remained high. Two patients underwent liver transplantation after a median of 113 days [IQR 105, 122] and were alive at 3‐year follow‐up.

In this multicentre retrospective analysis in a high‐risk CS cohort, SSC‐CIP was a rare yet serious complication of intensive care unit stay with high in‐hospital mortality. Treatment options are limited, and liver transplantation remains the only viable long‐term treatment option.