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Sepsis and Septic Shock in Cirrhotic Patients

  • Antonios KatsounasEmail author
Chapter

Abstract

Critically ill patients with liver cirrhosis are at risk of developing severe infections and specifically sepsis and/or septic shock. The subjects of this chapter are the epidemiology of and prognosis and critical care therapy for septic patients with liver failure. Severe hepatic dysfunction in association with sepsis and/or septic shock can result in a high mortality rate and requires intensive care management with specific expertise.

Keywords

Liver disease Cirrhosis sepsis Septic shock Scores 

References

  1. 1.
    Borzio M, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001;33(1):41–8.CrossRefGoogle Scholar
  2. 2.
    Bernard B, et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29(6):1655–61.CrossRefGoogle Scholar
  3. 3.
    Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28(1):26–42.CrossRefGoogle Scholar
  4. 4.
    Wasmuth HE, et al. Patients with acute on chronic liver failure display “sepsis-like” immune paralysis. J Hepatol. 2005;42(2):195–201.CrossRefGoogle Scholar
  5. 5.
    Rajkovic IA, Williams R. Abnormalities of neutrophil phagocytosis, intracellular killing and metabolic activity in alcoholic cirrhosis and hepatitis. Hepatology. 1986;6(2):252–62.CrossRefGoogle Scholar
  6. 6.
    Katsounas A, et al. Altered expression of SHIP, a toll-like receptor pathway inhibitor, is associated with the severity of liver fibrosis in chronic hepatitis C virus infection. J Infect Dis. 2011;204(8):1181–5.CrossRefGoogle Scholar
  7. 7.
    Strnad P, et al. Liver - guardian, modifier and target of sepsis. Nat Rev Gastroenterol Hepatol. 2017;14(1):55–66.CrossRefGoogle Scholar
  8. 8.
    Prin M, Bakker J, Wagener G. Hepatosplanchnic circulation in cirrhosis and sepsis. World J Gastroenterol. 2015;21(9):2582–92.CrossRefGoogle Scholar
  9. 9.
    Schneider KM, et al. CX3CR1 is a gatekeeper for intestinal barrier integrity in mice: limiting steatohepatitis by maintaining intestinal homeostasis. Hepatology. 2015;62(5):1405–16.CrossRefGoogle Scholar
  10. 10.
    Sharawy N. Vasoplegia in septic shock: do we really fight the right enemy? J Crit Care. 2014;29(1):83–7.CrossRefGoogle Scholar
  11. 11.
    Piano S, Bartoletti M, Tonon M, et al. Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections. Gut. Published Online First: 31 Aug 2017.  https://doi.org/10.1136/gutjnl-2017-314324 CrossRefGoogle Scholar
  12. 12.
    Jalan R, et al. The CLIF consortium acute decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol. 2015;62(4):831–40.CrossRefGoogle Scholar
  13. 13.
    Scaglione S, et al. The epidemiology of cirrhosis in the United States: a population-based study. J Clin Gastroenterol. 2015;49(8):690–6.CrossRefGoogle Scholar
  14. 14.
    Foreman MG, Mannino DM, Moss M. Cirrhosis as a risk factor for sepsis and death: analysis of the National Hospital Discharge Survey. Chest. 2003;124(3):1016–20.CrossRefGoogle Scholar
  15. 15.
    Gustot T, et al. Severe sepsis in cirrhosis. Hepatology. 2009;50(6):2022–33.CrossRefGoogle Scholar
  16. 16.
    Singer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.CrossRefGoogle Scholar
  17. 17.
    Shankar-Hari M, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):775–87.CrossRefGoogle Scholar
  18. 18.
    Seymour CW, et al. Assessment of clinical criteria for Sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762–74.CrossRefGoogle Scholar
  19. 19.
    Vincent JL, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.CrossRefGoogle Scholar
  20. 20.
    Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426–37, 1437.e1–9.CrossRefGoogle Scholar
  21. 21.
    Jalan R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310–24.CrossRefGoogle Scholar
  22. 22.
    Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77.CrossRefGoogle Scholar
  23. 23.
    Merli M, et al. Albumin infusion in cirrhotic patients with infections other than spontaneous bacterial peritonitis: end of the story? J Hepatol. 2015;63(3):767–8.CrossRefGoogle Scholar
  24. 24.
    Thevenot T, et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial. J Hepatol. 2015;62(4):822–30.CrossRefGoogle Scholar
  25. 25.
    Guevara M, et al. Albumin for bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. A randomized, controlled study. J Hepatol. 2012;57(4):759–65.CrossRefGoogle Scholar
  26. 26.
    Sort P, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341(6):403–9.CrossRefGoogle Scholar
  27. 27.
    Thevenot T, Monnet E, Di Martino V. Effect of albumin on survival in septic cirrhotic patients other than spontaneous bacterial peritonitis. The question remains open. J Hepatol. 2013;58(3):638–9.CrossRefGoogle Scholar
  28. 28.
    Guevara M, Arroyo V, Gines P. Reply to: “effect of albumin on survival in septic cirrhotic patients other than spontaneous bacterial peritonitis. The question remains open”. J Hepatol. 2013;58(3):640.CrossRefGoogle Scholar
  29. 29.
    Caraceni P, et al. Clinical indications for the albumin use: still a controversial issue. Eur J Intern Med. 2013;24(8):721–8.CrossRefGoogle Scholar
  30. 30.
    Roberts JA, et al. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect Dis. 2014;14(6):498–509.CrossRefGoogle Scholar
  31. 31.
    Iacobone E, et al. Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med. 2009;37(10 Suppl):S331–6.CrossRefGoogle Scholar
  32. 32.
    Ferenci P, et al. Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21.CrossRefGoogle Scholar
  33. 33.
    Tandon P, et al. Relevance of new definitions to incidence and prognosis of acute kidney injury in hospitalized patients with cirrhosis: a retrospective population-based cohort study. PLoS One. 2016;11(8):e0160394.CrossRefGoogle Scholar
  34. 34.
    Schiffer E, et al. Hepatopulmonary syndrome increases the postoperative mortality rate following liver transplantation: a prospective study in 90 patients. Am J Transplant. 2006;6(6):1430–7.CrossRefGoogle Scholar
  35. 35.
    Kauffmann RM, et al. Provision of balanced nutrition protects against hypoglycemia in the critically ill surgical patient. JPEN J Parenter Enteral Nutr. 2011;35(6):686–94.CrossRefGoogle Scholar
  36. 36.
    Findlay JY, et al. Critical care of the end-stage liver disease patient awaiting liver transplantation. Liver Transpl. 2011;17(5):496–510.CrossRefGoogle Scholar
  37. 37.
    Koulaouzidis A, et al. Spontaneous bacterial peritonitis. Postgrad Med J. 2007;83(980):379–83.CrossRefGoogle Scholar
  38. 38.
    Gustot T, et al. Sepsis in alcohol-related liver disease. J Hepatol. 2017;67(5):1031–50.CrossRefGoogle Scholar
  39. 39.
    Fernández J, Bert F, Nicolas-Chanoine M-H. The challenges of multi-drug-resistance in hepatology. J Hepatol. 2016;65(5):1043–54.CrossRefGoogle Scholar
  40. 40.
    The challenge of antimicrobial resistance. The Lancet Gastroenterology & Hepatology. 1(3):173. https://www.thelancet.com/pdfs/journals/langas/PIIS2468-1253(16)30121-2.pdf

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Infectious DiseasesDepartment of Gastroenterology, Hepatology and Infectious Diseases, University Hospital MagdeburgMagdeburgGermany

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