Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

Core Tip

Core Tip: Sepsis is a severe condition encountered in the intensive care unit (ICU), and when it occurs in cirrhotic patients, it often leads to high mortality due to impaired immunity and multiorgan failure. To diagnose and monitor sepsis in cirrhotic patients, various scoring systems have been developed, including the Sequential Organ Failure Assessment (SOFA) score, the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score, quick SOFA (qSOFA), Model for End-Stage Liver Disease (MELD), and MELD-Na score. Although the proposed current management of sepsis in cirrhotic patients might follow the guidelines proposed by the Surviving Sepsis Campaign, this approach has might not cause significant improvement in patient outcomes. Therefore, early recognition of infection and its source is critical, followed by timely initiation of antibiotic therapy, fluid resuscitation with albumin (5% or 20%), vasopressors, and low-dose corticosteroids such as hydrocortisone. Studies have shown that this approach reduces mortality in the ICU. In addition to pharmacological interventions, interventions to control the source of infection, such as surgical drainage, may also be necessary. Finally, procalcitonin levels can be used as a diagnostic biomarker in cirrhotic patients with sepsis, helping to guide antibiotic therapy and improve patient outcomes. In conclusion, timely recognition and management of sepsis in cirrhotic patients in the ICU is crucial, and early initiation of appropriate interventions, including antibiotics, fluids, and corticosteroids, may improve patient outcomes.