Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.451
Peer-review started: March 22, 2020
First decision: April 12, 2020
Revised: May 18, 2020
Accepted: June 27, 2020
Article in press: June 27, 2020
Published online: August 27, 2020
Sepsis and septic shock are catastrophic disease entities that portend high mortality in patients with cirrhosis. In cirrhosis, hemodynamic perturbations, immune dysregulation, and persistent systemic inflammation with altered gut microbiota in the background of portal hypertension enhance the risk of infections and resistance to antimicrobials. Patients with cirrhosis develop recurrent life-threatening infections that progress to multiple organ failure. The definition, pathophysiology, and treatment options for sepsis have been ever evolving. In this exhaustive review, we discuss novel advances in the understanding of sepsis, describe current and future biomarkers and scoring systems for sepsis, and delineate newer modalities and adjuvant therapies for the treatment of sepsis from existing literature to extrapolate the same concerning the management of sepsis in cirrhosis. We also provide insights into the role of gut microbiota in initiation and progression of sepsis and finally, propose a treatment algorithm for management of sepsis in patients with cirrhosis.
Core tip: Advances in understanding sepsis have led to an uncomplicated and robust definition with prognostic importance. What has emerged is a redefinition of the clinical protocols for early and aggressive management of sepsis at hour 1 of patient presentation and identification of a novel combination of biomarkers. In addition, antimicrobial resistance has been addressed and adjuvant therapies have been identified through deep data mining, metagenomics, and machine learning-based tools for improving clinical outcomes. These advances have the potential to be extrapolated and studied in patients with cirrhosis and sepsis to improve notable catastrophic clinical outcomes seen in this unique and challenging patient population.