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Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary candidiasis.
[cholangiocarcinoma]
Candidiasis
is
commonly
observed
in
patients
with
primary
sclerosing
cholangitis
(
PSC
)
,
but
the
clinical
risk
factors
associated
with
its
presence
have
not
been
fully
investigated
.
In
this
study
,
we
aimed
to
analyse
the
incidence
,
risk
factors
,
and
transplantation-free
survival
in
primary
sclerosing
cholangitis
(
PSC
)
patients
with
persistent
biliary
candidiasis
.
We
retrospectively
analysed
patients
diagnosed
with
PSC
who
were
admitted
to
our
department
during
2002
to
2012
.
One
-
hundred
fifty
patients
whose
bile
cultures
were
tested
for
fungal
species
were
selected
,
and
their
clinical
and
laboratory
parameters
were
investigated
.
The
results
of
endoscopic
retrograde
cholangiography
(
ERC
)
and
bile
cultures
were
analysed
using
chart
reviews
.
The
cases
of
biliary
candidiasis
were
sub-classified
as
transient
or
persistent
.
Thirty
out
of
150
(
20
.
0
%
)
patients
had
biliary
candidiasis
.
Although
all
patients
demonstrated
comparable
baseline
characteristics
,
those
with
biliary
candidiasis
showed
significantly
reduced
transplantation-free
survival
(
p
<
0
.
0001
)
along
with
a
markedly
elevated
frequency
of
cholangiocarcinoma
(
CCA
)
(
p
=
0
.
04
)
.
The
patients
were
further
sub-classified
according
to
the
transient
(
15
/
30
)
or
persistent
(
15
/
30
)
nature
of
their
biliary
candidiasis
.
A
subgroup
analysis
showed
reduced
survival
with
a
greater
necessity
for
orthotopic
liver
transplantation
(
OLT
)
only
in
patients
with
persistence
of
Candida
(
p
=
0
.
007
)
.
The
survival
in
the
patients
with
transient
biliary
candidiasis
was
comparable
to
that
in
candidiasis-free
patients
.
In
a
multivariate
regression
analysis
that
included
Mayo
risk
score
(
MRS
)
,
sex
,
age
,
dominant
stenosis
,
inflammatory
bowel
disease
,
autoimmune
hepatitis
overlap
syndrome
,
and
number
of
times
ERC
was
performed
,
biliary
candidiasis
was
an
independent
risk
factor
for
reduced
survival
(
p
=
0
.
008
)
.
Risk
factors
associated
with
acquisition
of
biliary
candidiasis
were
age
at
PSC
diagnosis
and
number
of
ERCs
.
T
he
persistence
of
biliary
candidiasis
is
associated
with
markedly
reduced
transplantation-free
survival
in
PSC
patients
.
By
contrast
,
actuarial
survival
in
patients
with
transient
biliary
candidiasis
approaches
that
for
patients
without
any
evidence
of
biliary
candidiasis
.
Further
studies
on
the
treatment
of
persistent
biliary
candidiasis
in
patients
with
PSC
are
warranted
.
Diseases
Validation
Diseases presenting
"inflammatory bowel disease"
symptom
acute rheumatic fever
benign recurrent intrahepatic cholestasis
cholangiocarcinoma
familial mediterranean fever
hirschsprung disease
legionellosis
malignant atrophic papulosis
primary effusion lymphoma
severe combined immunodeficiency
typhoid
This symptom has already been validated