TY - JOUR
T1 - Management of Sepsis in Patients With Cirrhosis
T2 - Current Evidence and Practical Approach
AU - Simonetto, Douglas A.
AU - Piccolo Serafim, Laura
AU - Gallo de Moraes, Alice
AU - Gajic, Ognjen
AU - Kamath, Patrick S.
N1 - Publisher Copyright:
© 2018 by the American Association for the Study of Liver Diseases.
PY - 2019/7
Y1 - 2019/7
N2 - Sepsis in patients with cirrhosis is associated with high mortality. An impaired immune response accounts for the increased infection risk observed in these patients. Hemodynamic and systemic changes suggestive of sepsis may be observed in patients with cirrhosis in the absence of infection; therefore, diagnosis and treatment of sepsis may be delayed. The optimal management of the critically ill patient with sepsis and cirrhosis has not been well established and is generally extrapolated from consensus guidelines and expert recommendations made for management of patients without cirrhosis with sepsis. Despite the lack of strong evidence, we propose a contemporary pragmatic approach to sepsis management in patients with cirrhosis, including the choice of fluids, vasopressors, and antibiotics.
AB - Sepsis in patients with cirrhosis is associated with high mortality. An impaired immune response accounts for the increased infection risk observed in these patients. Hemodynamic and systemic changes suggestive of sepsis may be observed in patients with cirrhosis in the absence of infection; therefore, diagnosis and treatment of sepsis may be delayed. The optimal management of the critically ill patient with sepsis and cirrhosis has not been well established and is generally extrapolated from consensus guidelines and expert recommendations made for management of patients without cirrhosis with sepsis. Despite the lack of strong evidence, we propose a contemporary pragmatic approach to sepsis management in patients with cirrhosis, including the choice of fluids, vasopressors, and antibiotics.
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U2 - 10.1002/hep.30412
DO - 10.1002/hep.30412
M3 - Review article
C2 - 30516866
AN - SCOPUS:85068039218
SN - 0270-9139
VL - 70
SP - 418
EP - 428
JO - Hepatology
JF - Hepatology
IS - 1
ER -