Emerging concepts in the care of patients with cirrhosis and septic shock

Jose Victor Jimenez, Guadalupe Garcia-Tsao, Saad Saffo*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.

Original languageEnglish (US)
Pages (from-to)497-514
Number of pages18
JournalWorld Journal of Hepatology
Volume15
Issue number4
DOIs
StatePublished - Apr 27 2023

Keywords

  • Antibiotics
  • Cirrhosis
  • Intravenous fluids
  • Septic shock
  • Steroids
  • Vasopressors

ASJC Scopus subject areas

  • Hepatology

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