{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:24:17Z","timestamp":1787675057297,"version":"build-2784847793"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":48,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["j intensive care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a severe cholangiopathy with high mortality observed in ICU survivors. While prolonged mechanical ventilation and COVID-19-associated acute respiratory distress syndrome (ARDS) are established risk factors, the impact of ketamine, a commonly used sedative, remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 20,973 ICU patients admitted between January 2014 and February 2022 at a tertiary university hospital. Patients with severe cholestasis were preselected (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009532) and reviewed for SSC-CIP diagnosis or likelihood of SSC-CIP. Multivariate logistic regression was used to evaluate Esketamine exposure and dose dependency while controlling for other risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SSC-CIP was confirmed in 0.11% of patients; 0.20% had clinical profiles compatible with undiagnosed SSC-CIP. Among COVID-19 ICU patients, the incidence was 3.24%. Esketamine administration was significantly associated with SSC-CIP (70% of SSC cases vs. 7% controls). In a multivariate analysis, cumulative Esketamine dose (OR 1.021 per gram), ICU duration (OR 1.031\/day), and COVID-19 status (OR 20.6) were independent predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Esketamine exposure was associated with SSC-CIP in a dose-dependent manner, highlighting the need for judicious sedative use in critically ill patients. Our cholestasis-first screening strategy also demonstrates a novel approach for detecting previously unrecognized SSC-CIP cases. Future prospective trials should evaluate the benefits of ketamine-free sedation strategies in high-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40560-026-00906-2","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T13:03:58Z","timestamp":1783515838000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of esketamine exposure with secondary sclerosing cholangitis in critically ill patients: a retrospective cohort analysis of 20,000 ICU cases"],"prefix":"10.1186","volume":"14","author":[{"given":"Sebastian","family":"Zeiner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Rettenbacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus Michael","family":"Nowak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Duma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Schaden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian Peter","family":"Hammerle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Laxar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Adelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wohlrab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Kimberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"3","key":"906_CR1","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.jhep.2022.05.011","volume":"77","author":"European Association for the Study of the Liver","year":"2022","unstructured":"European Association for the Study of the Liver. 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