Infections in primary sclerosing cholangitis and inflammatory bowel disease: a systematic review and meta-analysis

Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that frequently coexists with inflammatory bowel disease (IBD). The risk of infections in patients with concurrent PSC-IBD remains unclear. The aim of this study was to identify the event rate of infections and associated risk factors in PSC-IBD patients.

MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 12, 2024 for studies examining event rate or risk factors for infection in patients with PSC-IBD. The primary outcome was the event rate of all-cause and site-specific infections as well as infection-related mortality. The secondary outcome was risk factors for infection. Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI) comparing the event rate of all-cause infections in PSC-IBD patients to those with just PSC and just IBD. I ² values more than 50% suggested substantial heterogeneity.

Eighty-one studies were included. The pooled event rate of all-cause infections in patients with PSC-IBD was 25.1% (95% CI, 17.0%-33.2%, I ² = 99.2%). PSC-IBD patients had significantly increased odds of all-cause infection (OR 3.67, 95% CI, 2.07-6.52, I ² = 41.9%), sepsis (OR 3.35, 95% CI, 2.29-4.91, I ² = 9.1%), and infection-related mortality (OR 11.25, 95% CI, 2.03-62.37, I ² = 0) compared to those with IBD but not those with PSC.

Patients with PSC-IBD appear to be at increased risk of all-cause infection, sepsis, and mortality compared to those with IBD alone.