Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2020; 12(8): 451-474
Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.451
Update on diagnosis and management of sepsis in cirrhosis: Current advances
Cyriac Abby Philips, Rizwan Ahamed, Sasidharan Rajesh, Tom George, Meera Mohanan, Philip Augustine
Cyriac Abby Philips, The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Rizwan Ahamed, Philip Augustine, Gastroenterology and Advanced G.I Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Sasidharan Rajesh, Tom George, Division of Hepatobiliary Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Meera Mohanan, Anaesthesia and Critical Care, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Author contributions: Philips CA designed and wrote the original draft and was involved in the revision; Ahamed R, Rajesh S, and George T were involved in the writing; Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, and Augustine P were involved in the editing of the manuscript; Rajesh S, Mohanan M, and Augustine P were involved in the review of the manuscript; George T was involved in the reformatting of the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Cyriac Abby Philips, MBBS, MD, Associate Chief Physician, The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, 10th Floor, E.M.C Hospital, NH-Bypass, Palarivattom, Kochi 682028, Kerala, India. abbyphilips@gmail.com
Received: March 22, 2020
Peer-review started: March 22, 2020
First decision: April 12, 2020
Revised: May 18, 2020
Accepted: June 27, 2020
Article in press: June 27, 2020
Published online: August 27, 2020
Core Tip

Core tip: Advances in understanding sepsis have led to an uncomplicated and robust definition with prognostic importance. What has emerged is a redefinition of the clinical protocols for early and aggressive management of sepsis at hour 1 of patient presentation and identification of a novel combination of biomarkers. In addition, antimicrobial resistance has been addressed and adjuvant therapies have been identified through deep data mining, metagenomics, and machine learning-based tools for improving clinical outcomes. These advances have the potential to be extrapolated and studied in patients with cirrhosis and sepsis to improve notable catastrophic clinical outcomes seen in this unique and challenging patient population.