Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2582-2592
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2582
Hepatosplanchnic circulation in cirrhosis and sepsis
Meghan Prin, Jan Bakker, Gebhard Wagener
Meghan Prin, Gebhard Wagener, Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, United States
Jan Bakker, Department of Intensive Care Unit, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
Author contributions: Prin M, Bakker J and Wagener G contributed equally to this work.
Conflict-of-interest: None of the authors have any conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gebhard Wagener, MD, Associate Professor, Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, P S Box 46 (PH-5), 630 West 168th Street, New York, NY 10032, United States. gw72@columbia.edu
Telephone: +1-212-3056494 Fax: +1-212- 3052182
Received: October 4, 2014
Peer-review started: October 4, 2014
First decision: October 29, 2014
Revised: November 15, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: March 7, 2015
Processing time: 156 Days and 14.9 Hours
Abstract

Hepatosplanchnic circulation receives almost half of cardiac output and is essential to physiologic homeostasis. Liver cirrhosis is estimated to affect up to 1% of populations worldwide, including 1.5% to 3.3% of intensive care unit patients. Cirrhosis leads to hepatosplanchnic circulatory abnormalities and end-organ damage. Sepsis and cirrhosis result in similar circulatory changes and resultant multi-organ dysfunction. This review provides an overview of the hepatosplanchnic circulation in the healthy state and in cirrhosis, examines the signaling pathways that may play a role in the physiology of cirrhosis, discusses the physiology common to cirrhosis and sepsis, and reviews important issues in management.

Keywords: Liver cirrhosis; Sepsis; Splanchnic circulation; Hepatic circulation; Hepatic artery buffer response

Core tip: The prevalence of cirrhosis in critically ill patients is increasing worldwide. Cirrhosis leads to hepatosplanchnic circulatory abnormalities and end-organ damage, which resemble the clinical syndrome of patients with sepsis. The pathophysiology of cirrhosis can both predispose patients to, and exacerbate, sepsis. An understanding of this pathophysiology may assist critical care providers in the development and application of treatment modalities.