You are here

Article Text

Article menu
Download PDFPDF
Recent advances in clinical practice
Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club
  1. F Wong1,
  2. M Bernardi2,
  3. R Balk3,
  4. B Christman4,
  5. R Moreau5,
  6. G Garcia-Tsao6,
  7. D Patch7,
  8. G Soriano8,
  9. J Hoefs9,
  10. M Navasa10,
  11. on behalf of the International Ascites Club
  1. 1Division of Gastroenterology, Toronto General Hospital, University of Toronto, Canada
  2. 2Department Medicina Interna, Cardioangiologia, Epatologia, Alma Mater Studiorum, Università di Bologna, Italy
  3. 3Rush Medical College and Rush-Presbyterian, St Luke’s Medical Center, Chicago, Illinois, USA
  4. 4Vanderbilt University, Nashville, Tennessee, USA
  5. 5INSERM U-481 et Service d’Hepatologie, Hopital Beaujon, Clichy, France
  6. 6Digestive Diseases Section, Yale University School of Medicine, New Haven, Connecticut, USA
  7. 7Centre for Hepatology, Royal Free and University College Medical School, London, UK
  8. 8Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  9. 9University of California-Irvine Medical Center, Orange, California, USA
  10. 10Liver Unit, Hospital Clinic, Barcelona and the University of Barcelona School of Medicine, Barcelona, Spain
  1. Correspondence to:
    Dr F Wong
    9N/983 Toronto General Hospital, 200 Elizabeth St, Toronto, M5G2C4, Ontario, Canada; florence.wongutoronto.ca

https://doi.org/10.1136/gut.2004.038679

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    SUMMARY

    Sepsis is a systemic inflammatory response to the presence of infection, mediated via the production of many cytokines, including tumour necrosis factor α (TNF-α), interleukin (IL)-6, and IL-1, which cause changes in the circulation and in the coagulation cascade. There is stagnation of blood flow and poor oxygenation, subclinical coagulopathy with elevated D-dimers, and increased production of superoxide from nitric oxide synthase. All of these changes favour endothelial apoptosis and necrosis as well as increased oxidant stress. Reduced levels of activated protein C, which is normally anti-inflammatory and antiapoptotic, can lead to further tissue injury. Cirrhotic patients are particularly susceptible to bacterial infections because of increased bacterial translocation, possibly related to liver dysfunction and reduced reticuloendothelial function. Sepsis ensues when there is overactivation of pathways involved in the development of the sepsis syndrome, associated with complications such as renal failure, encephalopathy, gastrointestinal bleed, and shock with decreased survival. Thus the treating physician needs to be vigilant in diagnosing and treating bacterial infections in cirrhosis early, in order to prevent the development and downward spiral of the sepsis syndrome. Recent advances in management strategies of infections in cirrhosis have helped to improve the prognosis of these patients. These include the use of prophylactic antibiotics in patients with gastrointestinal bleed to prevent infection and the use of albumin in patients with spontaneous bacterial peritonitis to reduce the incidence of renal impairment. The use of antibiotics has to be judicious, as their indiscriminate use can lead to antibiotic resistance with potentially disastrous consequences.

    INTRODUCTION

    Bacterial infections are a common complication of cirrhosis.1,2 Once infection develops, renal failure, shock, and encephalopathy may follow, which adversely affect survival. In fact, the inhospital mortality of cirrhotic patients with infection is approximately 15%, more than twice that of patients without infection. More importantly, infection is directly …

    View Full Text

    Footnotes

    • Conflict of interest: None declared.