中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 35 Issue 11
Nov.  2019
Turn off MathJax
Article Contents

Research advances in the diagnosis and treatment of acute-on-chronic liver failure with infection

DOI: 10.3969/j.issn.1001-5256.2019.11.046
Research funding:

 

  • Received Date: 2019-06-17
  • Published Date: 2019-11-20
  • Acute-on-chronic liver failure( ACLF) is a severe syndrome of liver diseases commonly seen in clinical practice and can lead to severe disorders and decompensation of liver synthesis,metabolism,detoxification,and biotransformation,as well as multiple organ failure and an extremely high short-term mortality rate. Infection can induce or aggravate the condition of ACLF and is an independent influencing factor for patient prognosis. This article describes the mechanism and characteristics of ACLF with infection,summarizes the common types and clinical features of infection,reviews the recommended anti-infective regimens,and emphasizes the importance of early prophylactic treatment. ACLF patients with infection tend to have critical conditions,and early diagnosis and empirical anti-infective treatment is the key to successful treatment.

     

  • loading
  • [1] SARIN SK,KEDARISETTY CK,ABBAS Z,et al. Acute-onchronic liver failure:Consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)2014[J]. Hepatol Int,2014,8(4):453-471.
    [2] SARIN SK,CHOUDHURY A,SHARMA MK,et al. Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific association for the study of the liver(APASL):An update[J]. Hepatol Int,2019,13(4):353-390.
    [3] MOREAU R,JALAN R,GINES P,et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology,2013,144(7):1426-1437.
    [4] ARROYO V,MOREAU R,KAMATH PS,et al. Acute-onchronic liver failure in cirrhosis[J]. Nat Rev Dis Primers,2016,2:16041.
    [5] MOREAU R. The pathogenesis of ACLF:The inflammatory response and immune function[J]. Semin Liver Dis,2016,36(2):133-140.
    [6] GUSTOT T,DURAND F,LEBREC D,et al. Severe sepsis in cirrhosis[J]. Hepatology,2009,50(6):2022-2033.
    [7] TAKEUCHI O,AKIRA S. Pattern recognition receptors and inflammation[J]. Cell,2010,140(6):805-820.
    [8] MEDZHITOV R. Origin and physiological roles of inflammation[J]. Nature,2008,454(7203):428-435.
    [9] IWASAKI A,MEDZHITOV R. Control of adaptive immunity by the innate immune system[J]. Nat Immunol,2015,16(4):343-353.
    [10] KONO H,ROCK KL. How dying cells alert the immune system to danger[J]. Nat Rev Immunol,2008,8(4):279-289.
    [11] HERNAEZ R,SOLA E,MOREAU R,et al. Acute-on-chronic liver failure:An update[J]. Gut,2017,66(3):541-553.
    [12] FERNANDEZ J,ACEVEDO J,WIEST R,et al. Bacterial and fungal infections in acute-on-chronic liver failure:Prevalence,characteristics and impact on prognosis[J]. Gut,2018,67(10):1870-1880.
    [13] BAJAJ JS,O'LEARY JG,REDDY KR,et al. Second infections independently increase mortality in hospitalized patients with cirrhosis:The North American consortium for the study of end-stage liver disease(NACSELD)experience[J]. Hepatology,2012,56(6):2328-2335.
    [14] SHI Y,YANG Y,HU Y,et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J]. Hepatology,2015,62(1):232-242.
    [15] BELLOT P,FRANCES R,SUCH J. Pathological bacterial translocation in cirrhosis:Pathophysiology,diagnosis and clinical implications[J]. Liver Int,2013,33(1):31-39.
    [16] WASMUTH HE,KUNZ D,YAGMUR E,et al. Patients with acute on chronic liver failure display"sepsis-like"immune paralysis[J]. J Hepatol,2005,42(2):195-201.
    [17] BERNSMEIER C,TRIANTAFYLLOU E,BRENIG R,et al. CD14(+)CD15(-)HLA-DR(-)myeloid-derived suppressor cells impair antimicrobial responses in patients with acute-onchronic liver failure[J]. Gut,2018,67(6):1155-1167.
    [18] APPENRODT B,GRUNHAGE F,GENTEMANN MG,et al. Nucleotide-binding oligomerization domain containing 2(NOD2)variants are genetic risk factors for death and spontaneous bacterial peritonitis in liver cirrhosis[J]. Hepatology,2010,51(4):1327-1333.
    [19] SENKERIKOVA R,de MARE-BREDEMEIJER E,FRANKOVA S,et al. Genetic variation in TNFA predicts protection from severe bacterial infections in patients with end-stage liver disease awaiting liver transplantation[J]. J Hepatol,2014,60(4):773-781.
    [20] NISCHALKE HD,BERGER C,ALDENHOFF K,et al. Toll-like receptor(TLR)2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis[J]. J Hepatol,2011,55(5):1010-1016.
    [21] HASSAN EA,ABD EL-REHIM AS,HASSANY SM,et al. Fungal infection in patients with end-stage liver disease:Low frequency or low index of suspicion[J]. Int J Infect Dis,2014,23:69-74.
    [22] European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J]. J Hepatol,2010,53(3):397-417.
    [23] NAHON P,LESCAT M,LAYESE R,et al. Bacterial infection in compensated viral cirrhosis impairs 5-year survival(ANRS CO12Cir Vir prospective cohort)[J]. Gut,2015,66(2):330-341.
    [24] BAJAJ JS,O'LEARY JG,RAJENDER KR,et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures[J]. Hepatology,2014,60(1):250-256.
    [25] MANDELL LA,WUNDERINK RG,WATERER GW. Community-acquired pneumonia[J]. N Engl J Med,2015,373(3):292-294
    [26] FERNANDEZ J,ACEVEDO J,WIEST R,et al. Bacterial and fungal infections in acute-on-chronic liver failure:prevalence,characteristics and impact on prognosis[J]. Gut,2018,67(10):1870-1880.
    [27] BAJAJ JS,O'LEARY JG,WONG F,et al. Bacterial infections in end-stage liver disease:Current challenges and future directions[J]. Gut,2012,61(8):1219-1225.
    [28] VERMA N,SINGH S,TANEJA S,et al. Invasive fungal infections amongst patients with acute-on-chronic liver failure at high risk for fungal infections[J]. Liver Int,2019,39(3):503-513.
    [29] Society of Infectious Diseases,Chinese Medical Association.Expert consensus on diagnosis and treatment of end-stage liver disease complicated infection[J]. J Clin Hepatol,2018,34(9):1862-1872.(in Chinese)中华医学会感染病学分会.终末期肝病合并感染诊治专家共识[J].临床肝胆病杂志,2018,34(9):1862-1872.
    [30] STRNAD P,TACKE F,KOCH A,et al. Liver-guardian,modifier and target of sepsis[J]. Nat Rev Gastroenterol Hepatol,2017,14(1):55-66.
    [31] WIEST R,ALBILLOS A,TRAUNER M,et al. Targeting the gutliver axis in liver disease[J]. J Hepatol,2017,67(5):1084-1103.
    [32] VICTOR DW 3rd,QUIGLEY EM. Microbial therapy in liver disease:Probiotics probe the microbiome-gut-liver-brain axis[J]. Gastroenterology,2014,147(6):1216-1218.
    [33] MERLI M,LUCIDI C,di GREGORIO V,et al. The chronic use of beta-blockers and proton pump inhibitors may affect the rate of bacterial infections in cirrhosis[J]. Liver Int,2015,35(2):362-369.
    [34] UBEDA M,LARIO M,MUNOZ L,et al. Obeticholic acid reduces bacterial translocation and inhibits intestinal inflammation in cirrhotic rats[J]. J Hepatol,2016,64(5):1049-1057.
    [35] MOOKERJEE RP,PAVESI M,THOMSEN KL,et al. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure[J]. J Hepatol,2016,64(3):574-582.
    [36] MADSEN B S,HAVELUND T,KRAG A. Targeting the gut-liver axis in cirrhosis:Antibiotics and non-selective betablockers[J]. Adv Ther,2013,30(7):659-670.
    [37] de FRANCHIS R. Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol,2015,63(3):743-752.
    [38] HORVATH A,LEBER B,SCHMERBOECK B,et al. Randomised clinical trial:The effects of a multispecies probiotic vs.placebo on innate immune function,bacterial translocation and gut permeability in patients with cirrhosis[J]. Aliment Pharmacol Ther,2016,44(9):926-935.
    [39] GARCIA-MARTINEZ R,CARACENI P,BERNARDI M,et al.Albumin:Pathophysiologic basis of its role in the treatment of cirrhosis and its complications[J]. Hepatology,2013,58(5):1836-1846.
    [40] GUSTOT T. Beneficial role of G-CSF in acute-on-chronic liver failure:Effects on liver regeneration,inflammation/immunoparalysis or both?[J]. Liver Int,2014,34(4):484-486.
    [41] KHANAM A,TREHANPATI N,GARG V,et al. Altered frequencies of dendritic cells and IFN-gamma-secreting T cells with granulocyte colony-stimulating factor(G-CSF)therapy in acute-on-chronic liver failure[J]. Liver Int,2014,34(4):505-513.
    [42] KEDARISETTY CK,ANAND L,BHARDWAJ A,et al. Combination of granulocyte colony-stimulating factor and erythropoietin improves outcomes of patients with decompensated cirrhosis[J].Gastroenterology,2015,148(7):1362-1370. e7.
    [43] ROBERTO C,ENRICO G. Historical review of thymosinα1 in infectious diseases[J]. Expert Opin Biol Ther,2015,15(Suppl 1):s117-s127.
    [44] ANTY R,TONOHOUAN M,FERRARI-PANAIA P,et al. Low levels of 25-hydroxy vitamin D are independently associated with the risk of bacterial infection in cirrhotic patients[J]. Clin Transl Gastroenterol,2014,5:e56.
    [45] European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J]. J Hepatol,2010,53(3):397-417.
    [46] FERNANDEZ J,BERT F,NICOLAS-CHANOINE MH. The challenges of multi-drug-resistance in hepatology[J]. J Hepatol,2016,65(5):1043-1054.
    [47] PIANO S,FASOLATO S,SALINAS F,et al. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis:Results of a randomized,controlled clinical trial[J]. Hepatology,2016,63(4):1299-1309.
    [48] MERLI M,LUCIDI C,di GREGORIO V,et al. An empirical broad spectrum antibiotic therapy in health-care-associated infections improves survival in patients with cirrhosis:A randomized trial[J]. Hepatology,2016,63(5):1632-1639.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (1116) PDF downloads(296) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return