Short‐term Prognosis of Community‐Acquired Bacteremia in Patients with Liver Cirrhosis or Alcoholism: A Population‐Based Cohort Study

Linderoth, Gitte; Jepsen, Peter; Schønheyder, Henrik Carl; Johnsen, Søren Paaske; Sørensen, Henrik Toft

doi:10.1111/j.1530-0277.2006.00074.x

Cited by 57 publications

(40 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3][4] Neutrophils are an essential component of the innate immune response and key players in the pathogenesis of AH. 5 Data on neutrophil function in AH are paradoxical, with some studies suggesting neutrophil priming, indicating a readiness to respond to bacterial challenge (for a review, see Condliffe et al 6 ), as measured by hydrogen peroxide overproduction, decreased L-selectin expression, 7 and high levels of neutrophil elastase.…”

mentioning

confidence: 99%

Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome

et al. 2007

View full text Add to dashboard Cite

Mortality in patients with alcoholic hepatitis (AH) remains high, and although corticosteroids are widely used for treatment, the results vary considerably. In AH, neutrophils are primed and infiltrate the liver to produce injury, but paradoxically, the main cause of death in such patients is infection. Our prospective study addressed this paradox of primed neutrophils on the one hand and increased risk of infection on the other. We hypothesized that the full activation of neutrophils by a humoral factor such as endotoxin renders them unable to respond to further bacterial challenge. We analyzed neutrophil oxidative burst and phagocytosis in whole blood by fluorescence-activated cell sorting analysis in 63 alcoholic patients with cirrhosis and patients with cirrhosis with superimposed AH (cirrhosis؉AH). In 16 patients, ex vivo studies determined whether the removal of endotoxin restored neutrophil function. A resting burst greater than or equal to 5%, indicating neutrophil activation and a reduced phagocytic capacity lower than 42%, was associated with significantly greater risk of infection, organ failure, and mortality. This defective neutrophil function was transmissible through patients' plasma to normal neutrophils, and patients' neutrophil function could be restored by normal plasma. The ex vivo removal of endotoxin from patients' plasma decreased the resting burst and increased the phagocytic function. Conclusions: Our study provides the rationale for a goal-directed approach to the management of patients with cirrhosis and AH, in which the assessment of neutrophil function may be an important biomarker to select patients for immunosuppressive therapy. The neutrophil dysfunction in cirrhosis and AH is reversible, with endotoxin-removal strategies providing new targets for intervention. (HEPATOLOGY 2007;46:831-840.)

show abstract

mentioning

confidence: 99%

Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Infection is the cause in 30-50% of cirrhosis cases admitted to hospital, and a further 15-35% of cases develop nosocomial infections during their hospital stay compared with 5-7% in the general hospital population [8][9]. Patients with alcoholic cirrhosis have a 6.3-fold increased risk of dying from an episode of bacteremia [10], suggesting that cirrhosis increases the risk of infection.…”

Section: Liver Cirrhosismentioning

confidence: 99%

Störungen des angeborenen Immunsystems bei akuten und chronischen Lebererkrankungen

Leber

Mayrhauser

Rybczynski

et al. 2009

Wien Klin Wochenschr

View full text Add to dashboard Cite

Liver cirrhosis is a common disease causing great public-health concern because of the frequent complications requiring hospital care. Acute liver failure is also prone to several complications but is rare. One of the main complications for both acute and chronic liver diseases is infection, which regularly causes decompensation of cirrhosis, possibly leading to organ failure and death. This review focuses on innate immune function in cirrhosis, acute-on-chronic liver failure and acute liver failure. The known defects of Kupffer cells, neutrophils and monocytes are discussed, together with the pathophysiological importance of gut permeability, portal hypertension and intrinsic cellular defects, and the role of endotoxin, albumin, lipoproteins and toll-like receptors. Based on these different pathomechanisms, the available information on therapeutic strategies is presented. Antibiotic and probiotic treatment, nutritional support, artificial liver support, and experimental strategies such as inhibition of toll-like receptors and use of albumin and colony-stimulating factors are highlighted.

show abstract

“…It is estimated that approximately 50% of hospital admissions of patients with cirrhosis are for sepsis, with up to 40% of these patients developing further nosocomial infections [73] . The relationship between infection and SIRS indicates that an altered inflammatory response in patients with cirrhosis results in immune dysregulation, predisposing these patients to infection that results in a vicious cycle of inflammation [74] .…”

Section: Host Response To Injury/infectionmentioning

confidence: 99%

Acute-on-chronic liver failure: recent update

Alam

Suen

2016

J Biomed Res

View full text Add to dashboard Cite

Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria and management pathways. It is concerning that, despite our relative lack of understanding of the condition, the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%. This paper highlights our current understanding of ACLF, including its etiology, diagnostic and prognostic criteria and pathophysiology. It is evident that further refinement of the ACLF classification system is required in order to detect high-risk patients and improve short-term mortality rates. The field of metabolomics certainly warrants investigation to enhance diagnostic and prognostic parameters, while the use of granulocyte-colony stimulating factor is a promising future therapeutic intervention for patients with ACLF.

show abstract

Short‐term Prognosis of Community‐Acquired Bacteremia in Patients with Liver Cirrhosis or Alcoholism: A Population‐Based Cohort Study

Abstract: Liver cirrhosis and alcoholism were associated with a poor short-term prognosis for community-acquired bacteremia. Liver cirrhosis and alcoholism may have independent effects on the prognosis for patients with liver cirrhosis and bacteremia.

Cited by 57 publications

References 32 publications

Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome

Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome

Störungen des angeborenen Immunsystems bei akuten und chronischen Lebererkrankungen

Acute-on-chronic liver failure: recent update

Contact Info

Product

Resources

About