Hepatosplanchnic circulation in cirrhosis and sepsis

Table 1 Common features and difference of hepatic cirrhosis and sepsis

	Cirrhosis	Sepsis1
Prevalence in ICU population[1-3,124-126]	1%-3%	11%-33%
ICU mortality[4-8,127,128]	37%-74%	18%-61%
Clinical presentation[129]	Jaundice Enlarged collateral veins (i.e., esophageal varices, hemorrhoids, caput medusae) SIRS like presentation possible	Systemic inflammatory response syndrome (SIRS): Temp < 36 °C/> 38 °C Heart rate > 90 RR > 20 or PaCO2 < 32 WBC < 4 k or > 12 k and infection
Laboratory findings[129,130]	↓ Polymorphonuclear cells Thrombocytopenia Hypoalbuminemia Increased PT, INR Hyperlactatemia Hypoglycemia	↓ or ↑ polymorphonuclear cells Thrombocytopenia Increased PT, aPTT, INR Decreased fibrinogen
Bacteremia[94,131-134]	32%-41%	27%-31%
Sources of infection[6,128,135,136]
Respiratory	9%-61%	60%-64%
Abdominal	8%-30%	15%-19%
Bloodstream	17%-72%	13%-15%
Renal/urinary	7%-11%	11%-14%
Skin	7.1%	7%
Catheter-related	4%-5%	5%
Microbiology[6,128,135,136]
Gram-negative	52.7%-64%	49%-63%
Gram-positive	30%-56%	40%-47%
Fungi	10%-25%	10%-19%
Mediators associated with disease progression[47,61,71,72,105,106,137]	Endothelin, angiotensin, PAF, NO, TNF-α and HLA-DR, bacterial DNA, IL-1β, IL-2R, IL-6, IL-8 and IL-10	Endothelin, NO, LPS, LTA, lipoproteins, sTNF, bacterial DNA, peptidoglycans, IL-6, IL-8, IL-4, IL-10
Endotoxin levels[138,139]	↑↑	↑↑
Protein C activity[140,141]	↓↓	Predicts outcome
Mesenteric lymph nodes[95,142]	+	+

¹Sepsis includes patients without cirrhosis classified as having sepsis, severe sepsis, and septic shock. SIRS: Systemic inflammatory response syndrome; PT: Prothrombin time; aPTT: Activated partial thromboplastin time; INR: International normalized ratio; PAF: Platelet activating factor; NO: Nitric oxide; TNF: Tumor necrosis factor; HLA: Human leukocyte antigen; IL: Interleukin; LPS: Lipopolysaccharide; LTA: Lipoteichoic acid; sTNF: Soluble tumor necrosis factor.