Early Diagnosis and Prevention of Infections in Cirrhosis

Anand V. Kulkarni; Madhumita Premkumar; Juan P. Arab; Karan Kumar; Mithun Sharma; Nageshwar D. Reddy; Nagaraja R. Padaki; Rajender K. Reddy

doi:10.1055/a-1869-7607

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2022; 42(03): 293-312
DOI: 10.1055/a-1869-7607

Review Article

Early Diagnosis and Prevention of Infections in Cirrhosis

Authors

Anand V. Kulkarni

¹Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
Madhumita Premkumar

²Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Juan P. Arab

³Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
Karan Kumar

⁴Department of Hepatology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
Mithun Sharma

¹Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
Nageshwar D. Reddy

¹Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
Nagaraja R. Padaki

¹Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
Rajender K. Reddy

⁵Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania

Abstract

Strategies to prevent infection and improve outcomes in patients with cirrhosis. HAV, hepatitis A virus; HBV, hepatitis B virus; COVID-19, novel coronavirus disease 2019; NSBB, nonselective β-blocker; PPI, proton pump inhibitors.

Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infections. Sepsis is an immunological response to an infectious process that leads to end-organ dysfunction and death. Preventing infections may avoid the downstream complications, and early diagnosis of infections may improve the outcomes. In this review, we discuss the pathogenesis, diagnosis, and biomarkers of infection; the incremental preventive strategies for infections and sepsi; and the consequent organ failures in cirrhosis. Strategies for primary prevention include reducing gut translocation by selective intestinal decontamination, avoiding unnecessary proton pump inhibitors' use, appropriate use of β-blockers, and vaccinations for viral diseases including novel coronavirus disease 2019. Secondary prevention includes early diagnosis and a timely and judicious use of antibiotics to prevent organ dysfunction. Organ failure support constitutes tertiary intervention in cirrhosis. In conclusion, infections in cirrhosis are potentially preventable with appropriate care strategies to then enable improved outcomes.

Keywords

liver failure - infections - antibiotics - morbidity

Full Text

References

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