Moura FA, Siqueira AIAN. Gut-liver axis in sepsis-associated liver injury: Epidemiology, challenges and clinical practice. World J Gastroenterol 2025; 31(1): 99987 [DOI: 10.3748/wjg.v31.i1.99987]
Corresponding Author of This Article
Fabiana Andréa Moura, Professor, College of Nutrition, Federal University of Alagoas, Avenue Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceio 57072-970, Alagoas, Brazil. fabiana.moura@fanut.ufal.br
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
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/
World J Gastroenterol. Jan 7, 2025; 31(1): 99987 Published online Jan 7, 2025. doi: 10.3748/wjg.v31.i1.99987
Gut-liver axis in sepsis-associated liver injury: Epidemiology, challenges and clinical practice
Fabiana Andréa Moura, Aryana Isabelle de Almeida Neves Siqueira
Fabiana Andréa Moura, College of Nutrition, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil
Fabiana Andréa Moura, Aryana Isabelle de Almeida Neves Siqueira, College of Medicine, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil
Co-first authors: Fabiana Andréa Moura and Aryana Isabelle de Almeida Neves Siqueira.
Author contributions: Moura FA and Siqueira AIAN contributed equally in the conceptualization, data curation, methodology, investigation, original draft preparation, reviewing and editing, they are the co-first authors of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabiana Andréa Moura, Professor, College of Nutrition, Federal University of Alagoas, Avenue Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceio 57072-970, Alagoas, Brazil. fabiana.moura@fanut.ufal.br
Received: August 4, 2024 Revised: October 15, 2024 Accepted: November 13, 2024 Published online: January 7, 2025 Processing time: 126 Days and 18.8 Hours
Abstract
Although the liver has a remarkable regenerative capacity, sepsis-associated liver injury (SLI) is a complication often seen in intensive care units. Due to its role in immune and inflammatory regulation, the liver is particularly vulnerable during severe infections. Understanding the global prevalence, causes, and management of SLI is essential to improve outcomes and reduce healthcare costs. This paper aims to explore these factors, with an emphasis on identifying effective strategies for clinical management. Zhang et al’s bibliometric analysis of 787 publications (745 original articles and 42 reviews, mostly in animal models) from 2000 to 2023 highlights the growing interest in SLI, focusing on oxidative stress, gut microbiota, and inflammatory processes. Key components such as nuclear factor-kappa B and the NOD-like receptor thermal protein domain associated protein 3 inflammasome pathway, along with their links to gut microbiota imbalance and oxidative stress, are crucial for understanding SLI pathogenesis. The gut-liver axis, particularly the role of intestinal permeability and bacterial translocation in liver inflammation, is emphasized. In this context, bacterial translocation is especially relevant for critically ill patients, as it can exacerbate liver inflammation. The findings underscore the need for integrated care in intensive care units, prioritizing gut health and careful antibiotic use to prevent dysbiosis. Despite extensive research, there remains a lack of clinical trials to validate therapeutic approaches. The abundance of experimental studies highlights potential therapeutic targets, stressing the need for high-quality randomized clinical trials to translate these findings into clinical practice.
Core Tip: Liver-gut axis balance, with dysbiosis, oxidative stress and pro-inflammatory activity control, is linked to sepsis-associated liver injury onset and progression. Therefore, the search for therapeutics targeting these metabolic pathways should be carried out through well-designed clinical trials in order to find ways to support effective clinical treatments.
