Reticuloendothelial System Phagocytic Activity in Cirrhosis and Its Relation to Bacterial Infections and Prognosis

Abstract

The reticuloendothelial system phagocytic activity, estimated by the plasma elimination rate constant of 99mtechnetium-sulfur colloid, was studied in 41 decompensated cirrhotics and 10 normal subjects. The results were related to the incidence and type of bacterial infections occurring during hospitalization and follow-up, and to survival. The elimination rate constant of 99mtechnetium-sulfur colloid was lower in cirrhotic patients (0.168 +/- 0.007) (means +/- S.E.) than in normal subjects (0.220 +/- 0.005) (p less than 0.01). Cirrhotics were divided into two groups. Group I (16 patients) and Group II (25 patients) had normal or reduced elimination rate constant of 99mtechnetium-sulfur colloid, respectively. Both groups were similar in relation to clinical and biochemical data, hepatic blood flow, and wedged hepatic venous pressure. However, the liver scan and the elimination rate constant of indocyanine green were more altered in Group II. Patients in Group II developed acute bacterial infections more frequently than did patients in Group I. During hospitalization (24 +/- 2 days), bacteremia occurred in six patients in Group II and in none in Group I (p less than 0.05). During follow-up (28 +/- 3 months), 5 patients in Group II and none in Group I developed bacteremia (p less than 0.05). The cumulative survival rate of Group I patients was higher (p less than 0.05) than that of Group II patients at 3 months (100 vs. 80%), 6 months (94 vs. 68%), 24 months (74 vs. 42%), and 48 months (68 vs. 34%). We suggest that decompensated cirrhotics with depressed reticuloendothelial system phagocytic activity are at great risk to acquire bacteremia, and that reticuloendothelial system phagocytic activity has prognostic value in cirrhosis.

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

“…Like the cancer patients, the cirrhotic patients also had alterations in the immune defense mechanisms, including decreased reticuloendothelial phagocytic activity, deficient ascetic fluid opsonic activity, and qualitative neutrophil dysfunction (27)(28)(29)(30). In addition, the cirrhotic patients had impaired intestinal permeability due to intestinal congestion, edema, and local hypoxia due to portal hypertension (31-36).…”

Increased Rates of Periprosthetic Joint Infection in Patients With Cirrhosis Undergoing Total Joint Arthroplasty

“…This at-risk age group is also the primary group of patients who may elect to undergo total joint replacements during the next few decades. Patients with cirrhosis are at greater risk for surgical complications [31], partly owing to immune dysfunction [3,22]. However, there has been little research on patients with cirrhosis undergoing orthopaedic procedures.…”

Diagnóstico, manejo y prevención de infecciones en pacientes con cirrosis hepática

“…Este sistema participa en la remoción de microorganismos circulantes en la sangre y constituye un factor de defensa importante contra las infecciones, especialmente las bacteriemias 9 . El SRE se concentra principalmente en el hígado, involucra a las célu-las de Küpffer y otras células sinusoidales y su actividad está deprimida en pacientes con cirrosis hepática, aunque en esta última condición existe una actividad compensatoria esplénica y en la médula ósea 9 .…”

“…La actividad del SRE se ha evaluado mediante la depuración de tecnecio sulfurocoloide, más de la mitad de los pacientes con cirrosis hepática demuestra una actividad disminuida de este sistema 9 . Más aún, esta disminución se ha asociado a una mayor frecuencia de bacteriemia durante la hospitalización o seguimiento de estos pacientes y a una mayor mortalidad 9 .…”

“…Más aún, esta disminución se ha asociado a una mayor frecuencia de bacteriemia durante la hospitalización o seguimiento de estos pacientes y a una mayor mortalidad 9 . La menor actividad de este sistema no es predecible por los paráme-tros habituales de función hepática.…”