Clinical Consequences of Infection in Cirrhosis: Organ Failures and Acute‐on‐Chronic Liver Failure

Wong, Florence

doi:10.1002/cld.813

Cited by 11 publications

(9 citation statements)

References 26 publications

(36 reference statements)

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“…Infections are more frequent among patients with SIRS and are importantly related to prognosis in cirrhosis [ 38 , 39 ]. Similarly, ACLF is a frequent complication of advanced cirrhosis, commonly triggered by infection, and strongly related to mortality [ 40 ]. Therefore, as observed for cirrhotics in general, among patients hospitalized for acute decompensation of cirrhosis who developed SIRS, the prognosis is related to the severity of the acute insult and presence of organ failure.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis

Borgonovo

Baldin

Maggi

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background. Although recently challenged, systemic inflammatory response syndrome (SIRS) criteria are still commonly used in daily practice to define sepsis. However, several factors in liver cirrhosis may negatively impact its prognostic ability. Goals. To investigate the factors associated with the presence of SIRS, the characteristics of SIRS related to infection, and its prognostic value among patients hospitalized for acute decompensation of cirrhosis. Study. In this cohort study from two tertiary hospitals, 543 patients were followed up, up to 90 days. Data collection, including the prognostic models, was within 48 hours of admission. Results. SIRS was present in 42.7% of the sample and was independently associated with upper gastrointestinal bleeding (UGB), ACLF, infection, and negatively related to beta-blockers. SIRS was associated with mortality in univariate analysis, but not in multiple Cox regression analysis. The Kaplan–Meier survival probability of patients without SIRS was 73.0% and for those with SIRS was 64.7%. The presence of SIRS was not significantly associated with mortality when considering patients with or without infection, separately. Infection in SIRS patients was independently associated with Child-Pugh C and inversely related to UGB. Among subjects with SIRS, mortality was independently related to the presence of infection, ACLF, and Child-Pugh C. Conclusions. SIRS was common in hospitalized patients with cirrhosis and was of no prognostic value, even in the presence of infection.

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Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis

Borgonovo

Baldin

Maggi

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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“…Bacterial infection has gained increasing attention in the study of liver failure because it not only could cause acute insult, inducing the occurrence of ACLF, but also tends to simultaneously occur at different sites in ACLF patients. [33][34][35] Further, infectious complication has been proven to accelerate the deterioration of ACLF, thus contributing to the exceedingly high mortality of ACLF patients. [36][37][38] Our study also confirmed the significantly increased mortality in patients with infection.…”

Section: Discussionmentioning

confidence: 99%

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

et al. 2020

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Hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) is difficult to treat and carries a high risk of short‐term mortality. This study aimed to explore the effect of artificial liver support system (ALSS) on the survival of HBV‐ACLF patients and to investigate which HBV‐ACLF patients may benefit from ALSS treatment. We enrolled 132 patients hospitalized for HBV‐ACLF according to the criteria of the Chinese Group on the Study of Severe Hepatitis B‐ACLF (COSSH‐ACLF) from 425 ACLF patients who were determined to at least meet the Asian Pacific Association for the Study of the Liver criteria and followed up for 90 days. Overall 132 eligible patients were divided into two groups: standard medical treatment (SMT) group, which included 54 patients who underwent SMT alone, and ALSS group, which included 78 patients who underwent ALSS treatment plus SMT. The proportion of HBV‐ACLF grade 1, 2, and 3 was 57.69%, 37.18%, and 5.13% in the ALSS group and 51.85%, 35.19%, and 12.96% in the SMT group, respectively. Bacterial infection was present in 43.6% of patients in the ALSS group and in 55.6% of patients in the SMT group. The mortality rates in the ALSS group at 28 and 90 days were significantly lower than those in the SMT group (23.08% vs. 48.15% and 33.33% vs. 57.41%, P < 0.05). ALSS was an independent factor related to both the 28‐ and 90‐day survival of HBV‐ACLF patients. Particularly, a higher cumulative survival rate in either patients with HBV‐ACLF grade 1 or those with HBV‐ACLF with bacterial infection was observed in the ALSS group. Moreover, ALSS had an independent influence on mortality. Based on the COSSH‐ACLF criteria, ALSS could better improve the short‐term survival of HBV‐ACLF patients than SMT alone, especially in those with HBV‐ACLF grade 1 or HBV‐ACLF with infection.

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“…In general, pro-inflammatory immune responses are thought to drive progressive CLD through bystander cell damage and activation of fibrogenic and hepatocarcinogenic pathways. Anti-inflammatory responses may counter these injurious pro-inflammatory responses and slow pathogenesis, but excessive anti-inflammatory responses may inadvertently impair immune-mediated wound healing and induce a state of immune insufficiency leading to a vulnerability to bacterial infection and increase the risk of hepatic decompenzation, as seen in patients with liver cirrhosis ( 34 ). A number of immune cells contribute to liver inflammation in CLD, including resident macrophages (KCs), infiltrating monocyte-derived macrophages, T cells, dendritic cell (DC)s and neutrophils.…”

Section: Inflammation In Chronic Liver Diseasementioning

confidence: 99%

Immunomodulatory Role of the Extracellular Matrix Within the Liver Disease Microenvironment

et al. 2020

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Chronic liver disease when accompanied by underlying fibrosis, is characterized by an accumulation of extracellular matrix (ECM) proteins and chronic inflammation. Although traditionally considered as a passive and largely architectural structure, the ECM is now being recognized as a source of potent damage-associated molecular pattern (DAMP)s with immune-active peptides and domains. In parallel, the ECM anchors a range of cytokines, chemokines and growth factors, all of which are capable of modulating immune responses. A growing body of evidence shows that ECM proteins themselves are capable of modulating immunity either directly via ligation with immune cell receptors including integrins and TLRs, or indirectly through release of immunoactive molecules such as cytokines which are stored within the ECM structure. Notably, ECM deposition and remodeling during injury and fibrosis can result in release or formation of ECM-DAMPs within the tissue, which can promote local inflammatory immune response and chemotactic immune cell recruitment and inflammation. It is well described that the ECM and immune response are interlinked and mutually participate in driving fibrosis, although their precise interactions in the context of chronic liver disease are poorly understood. This review aims to describe the known pro-/anti-inflammatory and fibrogenic properties of ECM proteins and DAMPs, with particular reference to the immunomodulatory properties of the ECM in the context of chronic liver disease. Finally, we discuss the importance of developing novel biotechnological platforms based on decellularized ECM-scaffolds, which provide opportunities to directly explore liver ECM-immune cell interactions in greater detail.

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Clinical Consequences of Infection in Cirrhosis: Organ Failures and Acute‐on‐Chronic Liver Failure

Cited by 11 publications

References 26 publications

Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis

Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Immunomodulatory Role of the Extracellular Matrix Within the Liver Disease Microenvironment

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