Early Diagnosis and Prevention of Infections in Cirrhosis

作者：Anand Vijay Kulkarni, Madhumita Premkumar, Juan Pablo Arab, Karan Kumar, Mithun Sharma, D. Nageshwar Reddy, Nagaraja Rao Padaki, K. Rajender Reddy · 发表于：Seminars in Liver Disease · 年份：2022 · DOI：10.1055/a-1869-7607 · 被引用次数：41 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Hepatitis Viruses Studies and Epidemiology

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.