scholarly journals Bacterial infections in patients with liver cirrhosis

2011 ◽  
Vol 2 (3) ◽  
pp. 147-159
Author(s):  
Giacomo Zaccherini ◽  
Vittoria Bevilacqua ◽  
Barbara Benazzi ◽  
Lucia Santi ◽  
Paolo Caraceni ◽  
...  
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Human Albumin ◽  
Multiple Organ ◽  
Clinical Factor ◽  
Systemic Complications ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Unfavourable Prognosis

Bacterial infections represent a frequent complication of liver cirrhosis carrying a significantly greater risk of morbidity and mortality as compared to that observed in non-cirrhotic patients. Such unfavourable prognosis is related to the systemic complications (liver and renal failure, shock, coagulopathy, multiple organ failure) induced by a series of pro-inflammatory and immunological systems which are activated by bacteria and their pathogenetic products.The epidemiology of bacterial infections in cirrhosis has changed in the last years with a marked increase of Gram+ infections and the emergence of multi-resistant bacteria.The severity of liver disease represents the major clinical factor predisposing to bacterial infections, which are asymptomatic or paucisymptomatic at presentation in almost half of the cases. Aim of this review is to summarise the clinical and therapeutic aspects of bacterial infections in cirrhotic patients. The most common sites of infection are the urinary tract, ascites, blood, lungs and soft tissues.Beside antibiotics, it has been proposed the administration of human albumin to prevent the development of renal failure in patients with spontaneous bacterial peritonitis and, more recently, the use of hydrocortisone to treat cirrhotic patients with septic shock.

scholarly journals Bacterial infections in patients with liver cirrhosis

2011 ◽  
Vol 2 (3) ◽  
pp. 147
Author(s):  
Giacomo Zaccherini ◽  
Vittoria Bevilacqua ◽  
Barbara Benazzi ◽  
Lucia Santi ◽  
Paolo Caraceni ◽  
...  
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Human Albumin ◽  
Multiple Organ ◽  
Clinical Factor ◽  
Systemic Complications ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Unfavourable Prognosis

Bacterial infections represent a frequent complication of liver cirrhosis carrying a significantly greater risk of morbidity and mortality as compared to that observed in non-cirrhotic patients. Such unfavourable prognosis is related to the systemic complications (liver and renal failure, shock, coagulopathy, multiple organ failure) induced by a series of pro-inflammatory and immunological systems which are activated by bacteria and their pathogenetic products.The epidemiology of bacterial infections in cirrhosis has changed in the last years with a marked increase of Gram+ infections and the emergence of multi-resistant bacteria.The severity of liver disease represents the major clinical factor predisposing to bacterial infections, which are asymptomatic or paucisymptomatic at presentation in almost half of the cases. Aim of this review is to summarise the clinical and therapeutic aspects of bacterial infections in cirrhotic patients. The most common sites of infection are the urinary tract, ascites, blood, lungs and soft tissues.Beside antibiotics, it has been proposed the administration of human albumin to prevent the development of renal failure in patients with spontaneous bacterial peritonitis and, more recently, the use of hydrocortisone to treat cirrhotic patients with septic shock.

scholarly journals Bacterial Infections in Cirrhosis

2004 ◽  
Vol 18 (6) ◽  
pp. 405-406 ◽  
Author(s):  
Guadalupe Garcia-Tsao
Keyword(s):  
Renal Failure ◽  
Bacterial Infections ◽  
Generation Cephalosporin ◽  
Variceal Hemorrhage ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
Synthetic Function ◽  
Cirrhotic Patients ◽  
Tract Infections

Hospitalized patients with cirrhosis are at increased risk of developing bacterial infections, the most common being spontaneous bacterial peritonitis (SBP) and urinary tract infections. Independent predictors of the development of bacterial infections in hospitalized cirrhotic patients are poor liver synthetic function and admission for gastrointestinal hemorrhage. Short term (seven-day) prophylaxis with norfloxacin reduces the rate of infections and improves survival and should therefore be administered to all patients with cirrhosis and variceal hemorrhage. Cirrhotic patients who develop abdominal pain, tenderness, fever, renal failure or hepatic encephalopathy should undergo diagnostic paracentesis, and those who meet the criterion for SBP (eg, an ascites neutrophil count greater than 250/mm3) should receive antibiotics, preferably a third-generation cephalosporin. In addition to antibiotic therapy, albumin infusions have been shown to reduce the risk of renal failure and mortality in patients with SBP, particularly in those with renal dysfunction and hyperbilirubinemia at the time of diagnosis. Patients who recover from an episode of SBP should be given long term prophylaxis with norfloxacin and should be assessed for liver transplantation.

scholarly journals Assessment of serum 25-hydroxy vitamin D in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S M Shalaby ◽  
E M Baiumy ◽  
M G Abdelrahman ◽  
M M Sayed ◽  
R M Abdelhalim ◽  
...  
Keyword(s):  
Vitamin D ◽  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Complete Blood Count ◽  
Decompensated Cirrhosis ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
25 Oh Vitamin D

Abstract Background Vitamin D has pleotropic effect including the immune function, it increases innate immunity and modifies lymphocyte activation. The risk for bacterial infections is increased in cirrhotic patients due to low levels of vitamin D, so its deficiency may be linked with the prevalence of SBP in cirrhotic patients Aim of the work To assess the 25-OH vitamin D serum level in cirrhotic patients and it’s relation to spontaneous bacterial peritonitis. Patient & Methods The current study included 90 patients divided into three groups; group one; patients with compensated liver cirrhosis, group two; patients with decompensated liver cirrhosis without SBP and group three; patients who had decompensated cirrhosis with SBP. The following laboratory work up was done: Serum 25-OH vitamin D level, liver functions test, kidney functions test, complete blood count, and ascitic neutrophil count. Results We report a highly significant difference between the studied groups as regards 25-OH vitamin D level, being lowest in group three. A negative correlation between markers of severe cirrhosis and vitamin D concentrations was found in our cirrhotic patients. Conclusion Vitamin D deficiency is associated with increased incidence of infections in cirrhotic patients including spontaneous bacterial peritonitis, suggesting that Vitamin D supplementation may be useful in these patients.

scholarly journals Assessment of serum 25-hydroxy vitamin D in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S M Shalaby ◽  
E M Baiumy ◽  
M G Abdelrahman ◽  
M M Sayed ◽  
R M Abdelhalim ◽  
...  
Keyword(s):  
Vitamin D ◽  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Complete Blood Count ◽  
Decompensated Cirrhosis ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
25 Oh Vitamin D

Abstract Background Vitamin D has pleotropic effect including the immune function, it increases innate immunity and modifies lymphocyte activation. The risk for bacterial infections is increased in cirrhotic patients due to low levels of vitamin D, so its deficiency may be linked with the prevalence of SBP in cirrhotic patients Aim of the work To assess the 25-OH vitamin D serum level in cirrhotic patients and it’s relation to spontaneous bacterial peritonitis. Patient & Methods The current study included 90 patients divided into three groups; group one; patients with compensated liver cirrhosis, group two; patients with decompensated liver cirrhosis without SBP and group three; patients who had decompensated cirrhosis with SBP. The following laboratory work up was done: Serum 25-OH vitamin D level, liver functions test, kidney functions test, complete blood count, and ascitic neutrophil count. Results We report a highly significant difference between the studied groups as regards 25-OH vitamin D level, being lowest in group three. A negative correlation between markers of severe cirrhosis and vitamin D concentrations was found in our cirrhotic patients. Conclusion Vitamin D deficiency is associated with increased incidence of infections in cirrhotic patients including spontaneous bacterial peritonitis, suggesting that Vitamin D supplementation may be useful in these patients.

The patient with hepatorenal syndrome

2018 ◽  
Author(s):  
Andrés Cárdenas ◽  
Pere Ginès
Keyword(s):  
Renal Failure ◽  
Liver Disease ◽  
Bacterial Infections ◽  
Hepatorenal Syndrome ◽  
Compensatory Response ◽  
Renal Vasoconstriction ◽  
Bacterial Peritonitis ◽  
Portosystemic Shunts ◽  
Line Of Therapy ◽  
End Stage

Hepatorenal syndrome (HRS) is a dreaded and common complication of patients with end-stage liver disease. The syndrome is characterized by functional renal failure due to renal vasoconstriction in the absence of underlying kidney pathology. The pathogenesis of HRS is the result of an extreme underfilling of the arterial circulation secondary to an arterial vasodilation located in the splanchnic circulation. This phenomenon triggers a compensatory response with activation of vasoconstrictor systems leading to intense renal vasoconstriction.Besides HRS, there are several other causes of renal failure in patients with cirrhosis including those secondary to bacterial infections, hypovolaemia, nephrotoxicity, and intrinsic renal disease. Thus, the diagnosis of HRS is based on established diagnostic criteria aimed at excluding non-functional causes of renal failure.The prognosis of patients with HRS is poor, especially in those who have a rapidly progressive course. Liver transplantation is the best option in suitable candidates, but it is not always applicable due to the short survival expectancy of listed candidates.Pharmacological therapies based on the use of vasoconstrictor drugs to reverse splanchnic vasodilation are the standard first line of therapy. The vasopressin analogue terlipressin is the best proven. Transjugular intrahepatic portosystemic shunts may be helpful in limited circumstances. Prevention of HRS can be attained with the use of albumin infusion in patients with spontaneous bacterial peritonitis, with norfloxacin in patients very advanced liver disease and with N-acetylcysteine in those with severe acute alcoholic hepatitis.

Predictive value of serum chemerin and nafld fibrosis score to ultrasonographic detection and quantification of steatosis in nonalcoholic fatty liver disease patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Essam Mohamed Byoumy ◽  
Azza Imam Mohamed ◽  
Wesam Ahmed Ibrahim ◽  
Ahmed Ibraheem Mohamed El-Shafie ◽  
Mohamed Magdy Salama ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Predictive Value ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Inflammatory Marker ◽  
Roc Curves ◽  
Nonalcoholic Fatty Liver ◽  
Bacterial Peritonitis ◽  
Nafld Fibrosis Score ◽  
Group B

Abstract Background It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in ascitic patients. Procalcitonin (PCT) is inflammatory marker used to diagnose severe bacterial infections. We evaluated the diagnostic role of this marker for spontaneous bacterial peritonitis (SBP) associated with liver cirrhosis. The aim of the study was to measure serum procalcitonin (PCT) levels to obtain an early diagnostic indication of SBP in ascitic patients. Methods A total of 90 patients diagnosed with liver cirrhosis devided in to three groups: Group (A):including 30 patients with SBP, Group (B) including 30ascitic patients without SBP and Group (C): including 30cirrhotic patients without ascites, groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels. Results Serum procalcitonin levels were determined to be significantly higher in patients with SBP compared to patients without SBP (median (min-max): 0.93 (0.4 - 1.23)vs. 0.13 (0.08 - 0.2), p = 0.100). Using ROC analysis, a serum procalcitonin level of > 0.315ng/mL (area under curve (AUC): 0.919, sensitivity: 87%, specificity: 97%, positive predictive value 96% and negative predictive value 88%) were determined to accurately help the diagnosis of spontaneous bacterial peritonitis. Conclusion According to our findings, determination of serum procalcitonin levels seems to provide accurate and rapid diagnosis of ascitic fluid infection.

scholarly journals Primary Terminal Haemochromatosis in a 50 Year-Old Patient

2021 ◽  
Vol 31 (1) ◽  
pp. 64-73
Author(s):  
M. I. Gonik ◽  
M. S. Zharkova ◽  
O. Yu. Kiseleva ◽  
E. V. Berezina ◽  
Sh. A. Ondos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Renal Failure ◽  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Dilated Cardiomyopathy ◽  
Organ Dysfunction ◽  
Paroxysmal Atrial Fibrillation ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction

Aim. A clinical description of end-stage hereditary haemochromatosis manifested with chronic alcohol abuse.Key points. A 50-yo patient referred with marked general weakness as a major complaint. The patient had a history of long-term alcohol consumption at toxic doses, putative cirrhosis, paroxysmal atrial fibrillation, type 2 diabetes mellitus. The patient's severity on admission was conditioned by marked hypotension. Further examination aimed at excluding occult gastrointestinal bleeding, adrenal insufficiency, decompensated heart failure. Bronze skin and icteric sclerae were positive. Blood tests revealed severe macrocytic hyperchromic anaemia, thrombocytopae-nia, hyperbilirubinaemia, hypoalbuminaemia, hypocoagulation, elevated transaminases, hyponatraemia, elevated creatinine (CKD DPI 63 mL/min), severe hyperferritinaemia. Faecal occult blood test and EGDS for bleeding were negative. Abdominal ultrasound exposed signs of liver cirrhosis and portal hypertension (ascites, splenomegaly). Echocardiographic evidence of dilated cardiomyopathy of all chambers, a reduced 24% ejection fraction at absent acute myocardial infarction. Primary haemochromatosis was suspected upon high ferritin, transferrin iron saturation and multiple organ dysfunction. Genotyping revealed the HFE 845G > A variant diagnostic of haemochromatosis type 1. Clinical diagnosis: Primary disease: haemochromatosis (homozygous variant HFE 845G > A (A/A)): liver cirrhosis, Child-Pugh class C. Portal hypertension: splenomegaly, ascites. Dilated cardiomyopathy. Diabetes mellitus. Complications: multiple organ dysfunction (SOFA 16). Liver failure: jaundice, hypoalbuminaemia, hypocoagulation. Cardiac rhythm and conduction disorder: paroxysmal atrial fibrillation. Acute cardiac failure with underlying CHF IIb, NYHA class 3. Acute renal failure (anuria) with underlying CKD stage 3 (CKD DPI 63 mL/min). Moderate macrocytic hyperchromic anaemia. Acute and chronic adrenal failure. Despite a cardiovascular and renal failure compensation therapy and albumin transfusion, the patient died. Autopsy revealed a marked organ infiltration with haemosiderin (heart, stomach, liver, pancreas, lungs, kidneys, adrenal glands).Conclusion. The case describes a classical clinical manifestation of haemochromatosis: bronze skin hyperpigmentation, liver cirrhosis, diabetes mellitus, cardiomyopathy, adrenal insufficiency. Terminal haemochromatosis, severe cardiac and renal failure decompensation precluded phlebotomy and chelation therapy. A lethal outcome was conditioned by multiple organ dysfunction with underlying massive haemosiderin deposition in most organs.

scholarly journals Evaluation of Serum Presepsin in the Diagnosis and the Prognosis of Cirrhotic Patients with Ascites

2021 ◽  
pp. 62-69
Author(s):  
Aziza Mohamed Hamed Zian ◽  
Mervat Abd El-Hameed Elkhateeb ◽  
Amira Youssef Ahmed ◽  
AL Zahraa Abd El-Azeam Allam
Keyword(s):  
Internal Medicine ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Significant Negative Correlation ◽  
Cross Sectional Study ◽  
Clinical Value ◽  
Cross Sectional ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Background: Liver cirrhosis is a serious problem associated with spontaneous bacterial peritonitis and renal dysfunction. Presepsin is a soluble Cluster of Differentiation 14 (CD14) Protein subtype that has been implicated as an important biomarker in many diseases. Objective: To assess the clinical value of presepsin as a diagnostic and prognostic marker for spontaneous bacterial peritonitis in cirrhotic patients.  Patients and Methods: This cross-sectional study was carried out on 60 cirrhotic patients with ascites. The data were collected from Internal Medicine Hospital Inward and ICUs of Internal Medicine. Results: Serum presepesin had a significant negative correlation with serum albumin (rs = -0.350, p = 0.006) and a significant positive correlation with platelet count (rs =0.547, p < 0.001). In the Spontaneous bacterial peritonitis (SBP) group, presepesin correlated significantly positively with total leukocytic count (rs =0.547, p < 0.001). The level of serum presepsin significantly increased with the group suffering from Hepatorenal syndrome (HRS) than the ascites group after adjusting for age, C-reactive Protein (CRP) level, and total leukocytic count. Similarly, the level of serum presepsin significantly increased with the SBP group than the ascites group after adjusting for age, CRP level, and total leukocytic count. Conclusion: presepsin is a promising biomarker in the diagnosis of bacterial infections and hepatorenal syndrome in cirrhosis. However, the diagnostic and prognostic value of presepsin needs further studies.

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