Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7252
Revised: February 9, 2014
Accepted: May 12, 2014
Published online: June 21, 2014
Processing time: 218 Days and 8.4 Hours
Despite major advances in the knowledge and management of liver diseases achieved in recent decades, decompensation of cirrhosis still carries a high burden of morbidity and mortality. Bacterial infections are one of the main causes of decompensation. It is very important for clinical management to be aware of the population with the highest risk of poor outcome. This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently. Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines. Moreover, it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and, in infected patients, with the degree of sepsis. It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection, severe sepsis, hepatorenal syndrome and death. We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.
Core tip: Despite major advances in the management of cirrhosis, it still carries high morbidity and mortality. Bacterial infection is one of the major causes of decompensation. This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infection reported recently. It summarizes the existing evidence for emergence of multiresistant bacteria, endothelial dysfunction, and relative adrenal insufficiency; and resultant changes in medical practice are given.