Sepsis in Patients With Cirrhosis Awaiting Liver Transplantation: New Trends and Management.
Rosa María Martin MateosAgustín Albillos MartínezPublished in: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (2019)
Bacterial infections are more frequent and severe in patients with advanced liver disease and, therefore, in liver transplant candidates. The increased risk of infection in these patients parallels the severity of the immune dysfunction associated with cirrhosis, which is related to systemic inflammation and progressive immunodeficiency. Other factors contribute to this risk, such as genetic polymorphisms, proton pump inhibitor overuse, the numerous invasive procedures and hospitalizations these patients go through, or the immunosuppressive effects of malnutrition or alcohol abuse. Bacterial infections have a great impact on disease progression and significantly increase mortality rates before and after liver transplantation. Mechanisms leading to organ failure in sepsis are associated not only with the hemodynamic derangement but also with an excessive inflammatory response triggered by infection. Furthermore, prophylactic and empirical antibiotic treatment strategies in patients with cirrhosis are being modified according to the growing prevalence of multidrug-resistant bacteria in the past decade. Also, new criteria have been introduced for the diagnosis of sepsis and septic shock. These new definitions have been validated in patients with cirrhosis and show a better accuracy to predict in-hospital mortality than previous criteria based on systemic inflammatory response syndrome. Accurate prophylaxis and early identification and treatment of bacterial infections are key to reducing the burden of sepsis in patients with cirrhosis awaiting liver transplantation.
Keyphrases
- septic shock
- inflammatory response
- end stage renal disease
- acute kidney injury
- intensive care unit
- ejection fraction
- newly diagnosed
- multidrug resistant
- chronic kidney disease
- risk factors
- prognostic factors
- lipopolysaccharide induced
- multiple sclerosis
- peritoneal dialysis
- patient reported outcomes
- oxidative stress
- mass spectrometry
- drug resistant
- physical activity
- weight loss
- body mass index
- cystic fibrosis
- pseudomonas aeruginosa
- klebsiella pneumoniae
- intimate partner violence