Risk factors and outcome of bacterial infections in cirrhosis

Abstract

Viable and non-viable pathological bacterial translocation promote a self-perpetuating circle of dysfunctional immune activation and systemic inflammation facilitating infections and organ failure in advanced cirrhosis. Bacterial infections and sepsis are now recognized as a distinct stage in the natural progression of chronic liver disease as they accelerate organ failure and contribute to the high mortality observed in decompensated cirrhosis. The increasing knowledge of structural, immunological and hemodynamic pathophysiology in advanced cirrhosis has not yet translated into significantly improved outcomes of bacterial infections over the last decades. Therefore, early identification of patients at the highest risk for developing infections and infection-related complications is required to tailor the currently available measures of surveillance, prophylaxis and therapy to the patients in need in order to improve the detrimental outcome of bacterial infections in cirrhosis.

Keywords: Immunity, Infection, Cirrhosis, Chronic liver disease, Bacterial translocation, Risk factors, Mortality

Core tip: We will discuss susceptibility and impact of specific bacterial infections in cirrhosis, their natural course and the identification of risk factors for organ failure and death in order to help clinicians identifying patients at the highest risk that may benefit from intensified surveillance, prophylaxis and therapy.