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J Hepatol. 2017 Nov;67(5):1031-1050. doi: 10.1016/j.jhep.2017.06.013. Epub 2017 Jun 22.

Sepsis in alcohol-related liver disease.

Author information

1
Dept. Gastroenterology and Hepato-Pancreatology, C.U.B. Erasme Hospital, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium; Inserm Unité 1149, Centre de Recherche sur l'inflammation (CRI), Paris, France; UMR S_1149, Université Paris Diderot, Paris, France; The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain. Electronic address: thierry.gustot@erasme.ulb.ac.be.
2
The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain; Liver Unit, Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain; CIBEREHED, Barcelona, Spain.
3
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
4
The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.
5
Service des maladies de l'appareil digestif, Hôpital Huriez, Lille, France.
6
The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain; UCL Institute for Liver and Digestive Health, Division of Medicine, UCL Medical School, Royal Free Hospital, London, UK.
7
Inserm Unité 1149, Centre de Recherche sur l'inflammation (CRI), Paris, France; UMR S_1149, Université Paris Diderot, Paris, France; The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain; Départment Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France; Laboratoire d'Excellence (Labex) Inflamex, CUE Sorbonne Paris Cité, Paris, France.
8
Dept. Gastroenterology and Hepato-Pancreatology, C.U.B. Erasme Hospital, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.

Abstract

Alcohol-related liver disease (ALD) remains the most important cause of death due to alcohol. Infections, particularly bacterial infections, are one of the most frequent and severe complications of advanced ALDs, such as alcoholic cirrhosis and severe alcoholic hepatitis (sAH). The specific mechanisms responsible for this altered host defence are yet to be deciphered. The aim of the present study is to review the current knowledge of infectious complications in ALD and its pathophysiological mechanisms, distinguishing the role of alcohol consumption and the contribution of different forms of ALD. To date, corticosteroids are the only treatment with proven efficacy in sAH, but their impact on the occurrence of infections remains controversial. The combination of an altered host defence and corticosteroid treatment in sAH has been suggested as a cause of opportunistic fungal and viral infections. A high level of suspicion with systematic screening and prompt, adequate treatment are warranted to improve outcomes in these patients. Prophylactic or preemptive strategies in this high-risk population might be a preferable option, because of the high short-term mortality rate despite adequate therapies. However, these strategies should be assessed in well-designed trials before clinical implementation.

KEYWORDS:

Alcoholic cirrhosis; Bacteria and fungus; Corticosteroids; Immune dysfunction; Infection; Severe alcoholic hepatitis

PMID:
28647569
DOI:
10.1016/j.jhep.2017.06.013
[Indexed for MEDLINE]

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