Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Fernández, Javier; Acevedo, Juan; Wiest, Reiner; Gustot, Thierry; Amorós, Àlex; Deulofeu, Carme; Reverter, Enric; Martínez, Javier; Saliba, Faouzi; Jalan, Rajiv; Welzel, Tania M.; Pavesi, Marco; Hernández-Tejero, María; Ginès, Pere; Arroyo, Vicente

doi:10.1136/gutjnl-2017-314240

Cited by 422 publications

(392 citation statements)

References 48 publications

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“…The systemic inflammation is a typical feature in all patients with ACLF and is not restricted to patients with a potential infection, although the latter can induce higher levels of inflammatory markers [1]. The actual challenge is to distinguish between patients with a high likelihood of an ongoing infection from those who have a ‘simple' sterile immune response.…”

Section: Diagnosticsmentioning

confidence: 99%

“…However, MR bacteria are often not considered for the initial empirical treatment of infection when culture results and resistance profiles are not yet available. As a consequence, multi-resistance leads to higher rates of septic shock (26 vs. 10%) and mortality rates of 67% [1,13,16,17,18]. …”

Section: Epidemiologymentioning

confidence: 99%

“…between 2-4%, it causes a mortality rate of about 70%. Frequent use of antibiotics and prolonged hospital stays may increase its frequency to nearly 10% [1,11,18,19,20]. …”

Section: Epidemiologymentioning

confidence: 99%

“…Up to 50% of patients with ACLF in general, and even more than 80% of critically ill patients with ACLF grade 3 develop infections during their hospital stay [1], which is significantly more than 20% in patients with simple acute decompensated liver cirrhosis [1,2]. The likelihood of infections is 4-5 times higher than in the normal population [3], suggesting that chronic liver disease patients are more sensitive to infection.…”

Section: Introductionmentioning

confidence: 99%

“…Bacterial infections are the most common complications of acute-on-chronic liver failure (ACLF), accounting for about one-fourth of all hospital admissions in patients with cirrhosis [1]. Up to 50% of patients with ACLF in general, and even more than 80% of critically ill patients with ACLF grade 3 develop infections during their hospital stay [1], which is significantly more than 20% in patients with simple acute decompensated liver cirrhosis [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Engelmann

Berg

2018

Visc Med

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Introduction: Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods: This review focuses on the best management strategies for patients with ACLF and infections. Using the following terms, an extensive literature research on the Medline database was performed: ‘acute-on-chronic liver failure', ‘infection', ‘ACLF', ‘bacteria', ‘multi-resistance'. Results: Analysis of the literature confirmed that delayed diagnosis and treatment of infections in patients with ACLF results in a poor prognosis. Patients with ACLF should be considered as having a potential infection and should undergo a complete screening for sepsis. Once biochemical analysis indicates a potential infection, such as abnormal levels of C-reactive protein and procalcitonin, antibiotic treatment should be initiated immediately without microbiological culture results. For community-acquired infections third-generation cephalosporins are still the first choice, whereas in the nosocomial setting antibiotics with broader spectrum, such as piperacillin/combactam or carbapenems ± glycopeptides, are preferred. The patient should be re-assessed 48 h after treatment initiation in order to tailor the treatment. Non-response is suspicious, likely due to bacterial resistance or fungal infection, which should be considered when choosing further treatment strategies. Albumin substitution to prevent hepatorenal syndrome and to improve patients' outcome is mandatory in patients with spontaneous bacterial peritonitis. Prophylactic antibiotic therapy is suitable to prevent infections in high-risk patients. Conclusion: The screening for infections and its treatment is an essential part of managing patients with ACLF. In order to improve patients' prognosis, antibiotic treatment should be initiated once an infection is suspected. However, preventive strategies are already established and should be applied according to the guidelines.

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Section: Diagnosticsmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

“…between 2-4%, it causes a mortality rate of about 70%. Frequent use of antibiotics and prolonged hospital stays may increase its frequency to nearly 10% [1,11,18,19,20]. …”

Section: Epidemiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Engelmann

Berg

2018

Visc Med

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Liver support systems for adults with acute-on-chronic liver failure

Martí‐Carvajal

Gluud

et al. 2022

Cochrane Database of Systematic Reviews

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Multimodal Tetrahedral DNA Nanoplatform for Surprisingly Rapid and Significant Treatment of Acute Liver Failure

Wei,

Yi,

et al. 2024

Advanced Materials

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Acute liver failure (ALF) is a life‐threatening disease associated with the rapid development of inflammatory storms, reactive oxygen species (ROS) level elevation, and hepatocyte necrosis, which results in high short‐term mortality. Except for liver transplantation, no effective strategies are available for ALF therapy due to the rapid disease progression and narrow therapeutic time window. Therefore, there is an urgent demand to explore fast and effective modalities for ALF treatment. Herein, a multifunctional tetrahedral DNA nanoplatform (TDN) is constructed by incorporating the tumor necrosis factor‐α siRNA (siTNF‐α) through DNA hybridization and antioxidant manganese porphyrin (MnP4) via π−π stacking interaction with G‐quadruplex (G4) for surprisingly rapid and significant ALF therapy. TDN‐siTNF‐α/‐G4‐MnP4 silences TNF‐α of macrophages by siTNF‐α and polarizes them to the anti‐inflammatory M2 phenotype, providing appropriate microenvironments for hepatocyte viability. Additionally, TDN‐siTNF‐α/‐G4‐MnP4 scavenges intracellular ROS by MnP4 and TDN, protecting hepatocytes from oxidative stress‐associated cell death. Furthermore, TDN itself promotes hepatocyte proliferation via modulating the cell cycle. TDN‐siTNF‐α/‐G4‐MnP4 shows almost complete liver accumulation after intravenous injection and exhibits excellent therapeutic efficacy of ALF within 2 h. The multifunctional DNA nanoformulation provides an effective strategy for rapid ALF therapy, expanding its application for innovative treatments for liver diseases.This article is protected by copyright. All rights reserved

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Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Cited by 422 publications

References 48 publications

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Liver support systems for adults with acute-on-chronic liver failure

Multimodal Tetrahedral DNA Nanoplatform for Surprisingly Rapid and Significant Treatment of Acute Liver Failure

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