Ndomba Nkola, Soldera Jonathan
Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom.
World J Hepatol. 2023 Jun 27;15(6):850-866. doi: 10.4254/wjh.v15.i6.850.
Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection, leading to life-threatening organ dysfunction. The "Third international consensus definitions for sepsis and septic shock (Sepsis-3)" defines sepsis as an increase in sequential organ failure assessment score of 2 points or more, with a mortality rate above 10%. Sepsis is a leading cause of intensive care unit (ICU) admissions, and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes. Therefore, it is critical to recognize and manage sepsis promptly by administering fluids, vasopressors, steroids, and antibiotics, and identifying and treating the source of infection.
To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU.
This study is a systematic literature review that followed the PRISMA statement's standardized search method. The search for relevant studies was conducted across multiple databases, including PubMed, Embase, Base, and Cochrane, using predefined search terms. One reviewer conducted the initial search, and the eligibility criteria were applied to the titles and abstracts of the retrieved articles. The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims.
The study findings indicate that cirrhotic patients are more susceptible to infections, resulting in higher mortality rates ranging from 18% to 60%. Early identification of the infection source followed by timely administration of antibiotics, vasopressors, and corticosteroids has been shown to improve patient outcomes. Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients. Moreover, presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis, with similar diagnostic performance compared to procalcitonin.
This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality. Therefore, early detection of infection using procalcitonin test and other biomarker as presepsin and resistin, associated with early management with antibiotics, fluids, vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.
脓毒症是一种严重的医学状况，当人体免疫系统对感染反应过度时就会发生，导致危及生命的器官功能障碍。“脓毒症和脓毒性休克的第三次国际共识定义（Sepsis - 3）”将脓毒症定义为序贯器官衰竭评估得分增加2分或更多，死亡率超过10%。脓毒症是重症监护病房（ICU）收治患者的主要原因，患有肝硬化等基础疾病的患者预后不良风险更高。因此，通过给予液体、血管加压药、类固醇和抗生素，并识别和治疗感染源，及时识别和管理脓毒症至关重要。
对ICU收治的肝硬化患者脓毒症管理的现有文献进行系统综述和荟萃分析，并比较ICU中肝硬化患者和非肝硬化患者的脓毒症管理情况。
本研究是一项遵循PRISMA声明标准化检索方法的系统文献综述。使用预定义的检索词在多个数据库中进行相关研究的检索，包括PubMed、Embase、Base和Cochrane。由一名审阅者进行初始检索，并将纳入标准应用于检索到的文章的标题和摘要。然后根据研究目标对选定的文章进行评估，以确保与研究目的相关。
研究结果表明，肝硬化患者更容易感染，死亡率更高，在18%至60%之间。早期识别感染源，随后及时给予抗生素、血管加压药和皮质类固醇已被证明可改善患者预后。降钙素原是诊断肝硬化患者感染的有用生物标志物。此外，已发现可溶性髓系细胞触发受体-1和抵抗素是失代偿期肝硬化患者细菌感染的可靠标志物，与降钙素原相比具有相似的诊断性能。
本综述强调了早期检测和管理肝硬化患者感染以降低死亡率的重要性。因此，使用降钙素原检测和其他生物标志物如可溶性髓系细胞触发受体-1和抵抗素进行早期感染检测，并结合抗生素、液体、血管加压药和低剂量皮质类固醇的早期管理，可能会降低肝硬化患者脓毒症相关的死亡率。
