Philips Cyriac Abby, Ahamed Rizwan, Rajesh Sasidharan, George Tom, Mohanan Meera, Augustine Philip
The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India.
Gastroenterology and Advanced G.I Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India.
World J Hepatol. 2020 Aug 27;12(8):451-474. doi: 10.4254/wjh.v12.i8.451.
Sepsis and septic shock are catastrophic disease entities that portend high mortality in patients with cirrhosis. In cirrhosis, hemodynamic perturbations, immune dysregulation, and persistent systemic inflammation with altered gut microbiota in the background of portal hypertension enhance the risk of infections and resistance to antimicrobials. Patients with cirrhosis develop recurrent life-threatening infections that progress to multiple organ failure. The definition, pathophysiology, and treatment options for sepsis have been ever evolving. In this exhaustive review, we discuss novel advances in the understanding of sepsis, describe current and future biomarkers and scoring systems for sepsis, and delineate newer modalities and adjuvant therapies for the treatment of sepsis from existing literature to extrapolate the same concerning the management of sepsis in cirrhosis. We also provide insights into the role of gut microbiota in initiation and progression of sepsis and finally, propose a treatment algorithm for management of sepsis in patients with cirrhosis.
脓毒症和脓毒性休克是灾难性的疾病实体，预示着肝硬化患者的高死亡率。在肝硬化中，血流动力学紊乱、免疫失调以及在门静脉高压背景下肠道微生物群改变导致的持续性全身炎症会增加感染风险和对抗菌药物的耐药性。肝硬化患者会发生反复的危及生命的感染，并进展为多器官功能衰竭。脓毒症的定义、病理生理学和治疗选择一直在不断发展。在这篇详尽的综述中，我们讨论了脓毒症认识方面的新进展，描述了脓毒症当前和未来的生物标志物及评分系统，并从现有文献中勾勒出治疗脓毒症的新方法和辅助疗法，以推断其在肝硬化脓毒症管理中的应用。我们还深入探讨了肠道微生物群在脓毒症发生和发展中的作用，最后提出了肝硬化患者脓毒症管理的治疗算法。
