Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2016; 22(26): 5958-5970
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.5958
Role of inflammation and infection in the pathogenesis of human acute liver failure: Clinical implications for monitoring and therapy
Mhairi C Donnelly, Peter C Hayes, Kenneth J Simpson
Mhairi C Donnelly, Peter C Hayes, Kenneth J Simpson, Department of Hepatology and Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Author contributions: Donnelly MC reviewed the literature and wrote the manuscript; Hayes PC critically reviewed the manuscript; and Simpson KJ conceived the idea for and critically reviewed the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Mhairi C Donnelly, Department of Hepatology and Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom. mhairi.donnelly@nhs.net
Telephone: +44-131-2421712 Fax: +44-131-2422065
Received: March 27, 2016
Peer-review started: March 28, 2016
First decision: May 12, 2016
Revised: May 25, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: July 14, 2016
Processing time: 100 Days and 20.2 Hours
Abstract

Acute liver failure is a rare and devastating clinical condition. At present, emergency liver transplantation is the only life-saving therapy in advanced cases, yet the feasibility of transplantation is affected by the presence of systemic inflammation, infection and resultant multi-organ failure. The importance of immune dysregulation and acquisition of infection in the pathogenesis of acute liver failure and its associated complications is now recognised. In this review we discuss current thinking regarding the role of infection and inflammation in the pathogenesis of and outcome in human acute liver failure, the implications for the management of such patients and suggest directions for future research.

Keywords: Inflammation; Neuroinflammation; Acute liver failure; Biomarker; Infection

Core tip: Acute liver failure is a serious and rare condition, for which emergency liver transplantation is the only rescue therapy in advanced cases. The medical need for liver transplantation and feasibility of such an intervention are affected by the presence of systemic inflammation and infection. This review will discuss current thinking with regards to the role of infection and inflammation in the pathogenesis of human acute liver failure, and its effect on outcome. We also provide clinical guidance for the management of these patients and suggest directions for future research.