Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections

Piano, Salvatore; Bartoletti, Michele; Tonon, Marta; Baldassarre, Maurizio; Chies, G.; Romano, A.; Viale, Pierluigi; Vettore, Elia; Domenicali, Marco; Stanco, M.; Pilutti, Chiara; Frigo, Anna Chiara; Brocca, Alessandra; Bernardi, Mauro; Caraceni, Paolo; Angeli, Paolo

doi:10.1136/gutjnl-2017-314324

Cited by 122 publications

(142 citation statements)

References 18 publications

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“…This hypothesis gains considerable support by recent studies in patients with cirrhosis and SBP reporting that combined treatment with intravenous albumin and an antibiotic reduces the risk for renal dysfunction/failure and mortality in comparison to therapy with a single antibiotic [39]. Last but not least, clinical investigations, which clearly identified white blood cell count and C-reactive protein (CRP) as independent predictors of in-hospital survival, add great evidence to the prognosis-relevant role of SI [64,65]. More information on 'immune dysregulation' is given by Lange and Moreau [66] in this focus issue of Visceral Medicine.…”

Section: Immune Dysfunctionmentioning

confidence: 74%

“…In addition, a 'leaky gut' favoring translocation of bacteria towards the bloodstream along with a gradually impaired hepatic clearance capacity for bacterial antigens, such as lipopolysaccharide (LPS) or endotoxin, may induce activation of toll-like receptor (TLR) pathways, and, thus, further enhance SI that accelerates fibrogenesis and progression to liver cirrhosis [63]. This, in turn, boosts cytokine secretion along with an ongoing synthesis of reactive oxygen species (ROS), thereby forming a vicious circle in the development of intestinal inflammation and tissue hyperpermeability [64,65]. In this light, it is reasonable to assume that some beneficial effects of albumin administration in cirrhotic patients with SBP and/or type-1 HRS might be largely attributable to its anti-inflammatory and antioxidative stress properties [36].…”

Section: Immune Dysfunctionmentioning

confidence: 99%

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Intensive Care Therapy for Patients with Advanced Liver Diseases

Katsounas

Canbay

2018

Visc Med

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Decompensated cirrhosis is characterized by high hospitalization rates and costs, frequent readmissions, and poor short-term survival. Patients admitted to the hospital with acute variceal bleeding and/or hepatic encephalopathy and/or renal dysfunction are at serious risk for developing infection and/or sepsis; in turn, this renders them highly susceptible to the development of multi-system organ failure. The lack of standardized intensive care unit management protocols in patients with cirrhosis along with only few data reports from longitudinal clinical trials makes it difficult for hepatologists and critical care specialists to provide uniform evidence for clinical practice that could safely consolidate favorable outcomes such as lower hospitalization rates and/or mortality. Based on a rigorous online search of the scientific literature as well as a longtime clinical experience of the authors in the field of hepatology and critical care medicine, this work represents a focused effort to elucidate the specific bio-morbidity of advanced liver diseases in relation to the aforementioned challenges in clinical management. Further meta-analyses and/or systematic reviews are needed to enable clinicians to develop more effective strategies to bridge patients with decompensated liver disease to recompensation or liver transplantation.

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Section: Immune Dysfunctionmentioning

confidence: 74%

Section: Immune Dysfunctionmentioning

confidence: 99%

Intensive Care Therapy for Patients with Advanced Liver Diseases

Katsounas

Canbay

2018

Visc Med

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“…In addition, a new score, the quick SOFA (qSOFA; [at least two of the following: alteration in mental status, systolic blood pressure ≤100 mm Hg or respiratory rate ≥22/min]) was suggested to screen for sepsis. More recently, both Sepsis‐3 criteria and qSOFA were shown to be more accurate than SIRS criteria in predicting in‐hospital mortality in patients with cirrhosis and bacterial infections . However, the availability of a baseline SOFA score is crucial to apply Sepsis‐3 criteria in patients with cirrhosis, thus, the combination of Sepsis‐3 criteria and qSOFA has been suggested in those without a baseline SOFA score (Figure ) …”

Section: Definition Of Sepsismentioning

confidence: 99%

“…ACLF is the main cause of mortality in patients with bacterial infections and strategies for preventing ACLF should be developed in infected patients. Patients with sepsis according to new definitions seem to be good candidates for these strategies . The increasing spread of MDR bacteria has made the management of patients with cirrhosis and bacterial infections more complex.…”

Section: Conclusion and Objectives Of Future Researchmentioning

confidence: 99%

Infections complicating cirrhosis

Piano

Brocca

Mareso

et al. 2018

Liver International

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145

122

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“…The short version of the sepsis criteria, the quick SOFA, includes any alteration of mental status, systolic blood pressure ≤100 mm Hg or respiratory rate ≥22 breaths/min, and might serve as a useful bedside test to quickly assess the likelihood of an infection. Piano et al [36] described its predictive capacity regarding the in-hospital mortality in patients with cirrhosis, which was significantly better than the conventional systemic inflammatory response syndrome (SIRS) criteria (AUROC of 0.732 vs. 0.606). However, its actual capacity to identify infections still needs to be evaluated.…”

Section: Diagnosticsmentioning

confidence: 99%

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Engelmann

Berg

2018

Visc Med

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Introduction: Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods: This review focuses on the best management strategies for patients with ACLF and infections. Using the following terms, an extensive literature research on the Medline database was performed: ‘acute-on-chronic liver failure', ‘infection', ‘ACLF', ‘bacteria', ‘multi-resistance'. Results: Analysis of the literature confirmed that delayed diagnosis and treatment of infections in patients with ACLF results in a poor prognosis. Patients with ACLF should be considered as having a potential infection and should undergo a complete screening for sepsis. Once biochemical analysis indicates a potential infection, such as abnormal levels of C-reactive protein and procalcitonin, antibiotic treatment should be initiated immediately without microbiological culture results. For community-acquired infections third-generation cephalosporins are still the first choice, whereas in the nosocomial setting antibiotics with broader spectrum, such as piperacillin/combactam or carbapenems ± glycopeptides, are preferred. The patient should be re-assessed 48 h after treatment initiation in order to tailor the treatment. Non-response is suspicious, likely due to bacterial resistance or fungal infection, which should be considered when choosing further treatment strategies. Albumin substitution to prevent hepatorenal syndrome and to improve patients' outcome is mandatory in patients with spontaneous bacterial peritonitis. Prophylactic antibiotic therapy is suitable to prevent infections in high-risk patients. Conclusion: The screening for infections and its treatment is an essential part of managing patients with ACLF. In order to improve patients' prognosis, antibiotic treatment should be initiated once an infection is suspected. However, preventive strategies are already established and should be applied according to the guidelines.

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Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections

Cited by 122 publications

References 18 publications

Intensive Care Therapy for Patients with Advanced Liver Diseases

Intensive Care Therapy for Patients with Advanced Liver Diseases

Infections complicating cirrhosis

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

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