State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Infectious Disease Department, The First People's Hospital of Wenling, Wenling, China.
Semin Liver Dis. 2018 May;38(2):121-133. doi: 10.1055/s-0038-1657751. Epub 2018 Jun 5.
Acute-on-chronic liver failure (ACLF) is a newly recognized clinical syndrome characterized by preexisting chronic liver disease or cirrhosis with organ failure and high 28-day mortality (50-90%). Bacterial infections (BIs) play pivotal roles in the development and progression of ACLF either as a main precipitating event or a specific complication. The main organisms isolated as triggering ACLF are Gram-positive bacteria, followed by Gram-negative bacteria. Spontaneous bacterial peritonitis, pneumonia, urinary tract infections, and skin infections are prevalent infections that trigger and complicate ACLF. Despite appropriate antibiotic treatment, BIs account for poor ACLF outcomes and lead to a worse clinical course and higher intensive care unit admission and short-term mortality. Early diagnosis and novel nonantibiotic methods are highly important for managing BIs. Thus, this review focuses on the epidemiology, prognosis, and diagnosis of and management strategies for BIs in ACLF patients as well as the relationship between BIs and ACLF.
急性慢性肝衰竭（ACLF）是一种新出现的临床综合征，其特征为存在慢性肝病或肝硬化，伴有器官衰竭和高 28 天死亡率（50-90%）。细菌感染（BI）在 ACLF 的发生和进展中起着关键作用，无论是作为主要诱发因素还是特定并发症。引发 ACLF 的主要分离菌为革兰阳性菌，其次为革兰阴性菌。自发性细菌性腹膜炎、肺炎、尿路感染和皮肤感染是常见的引发和加重 ACLF 的感染。尽管进行了适当的抗生素治疗，BI 仍与 ACLF 不良结局相关，并导致更差的临床病程以及更高的重症监护病房入住率和短期死亡率。早期诊断和新型非抗生素方法对于 BI 的管理非常重要。因此，本综述重点介绍 ACLF 患者 BI 的流行病学、预后、诊断和管理策略，以及 BI 与 ACLF 的关系。
