TY - JOUR
T1 - Emerging concepts in the care of patients with cirrhosis and septic shock
AU - Jimenez, Jose Victor
AU - Garcia-Tsao, Guadalupe
AU - Saffo, Saad
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
PY - 2023/4/27
Y1 - 2023/4/27
N2 - 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.
AB - 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.
KW - Antibiotics
KW - Cirrhosis
KW - Intravenous fluids
KW - Septic shock
KW - Steroids
KW - Vasopressors
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U2 - 10.4254/wjh.v15.i4.497
DO - 10.4254/wjh.v15.i4.497
M3 - Article
C2 - 37206653
AN - SCOPUS:85158141468
SN - 1948-5182
VL - 15
SP - 497
EP - 514
JO - World Journal of Hepatology
JF - World Journal of Hepatology
IS - 4
ER -