Kumar R, Kumar A, Kumar S. Sepsis in liver failure patients: Diagnostic challenges and recent advancements. World J Crit Care Med 2025; 14(2): 101587 [DOI: 10.5492/wjccm.v14.i2.101587]
Corresponding Author of This Article
Ramesh Kumar, MBBS, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
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 Crit Care Med. Jun 9, 2025; 14(2): 101587 Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.101587
Sepsis in liver failure patients: Diagnostic challenges and recent advancements
Ramesh Kumar, Abhishek Kumar, Sudhir Kumar
Ramesh Kumar, Abhishek Kumar, Sudhir Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Author contributions: Kumar R and Kumar A designed the concept, collected the data and wrote the manuscript research study; and Kumar S collected the data and wrote the manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: None of authors have any conflict of interest to declare pertaining to this submission.
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: Ramesh Kumar, MBBS, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Received: September 19, 2024 Revised: January 19, 2025 Accepted: February 12, 2025 Published online: June 9, 2025 Processing time: 160 Days and 17.6 Hours
Abstract
Acute liver failure (ALF) and acute-on-chronic LF (ACLF) are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections (BI), despite significant systemic inflammation. Literature indicates that 30%–80% of ALF patients and 55%–81% of ACLF patients develop BI, attributed to immunological dysregulation. Bacterial sepsis in these patients is associated with adverse clinical outcomes, including prolonged hospitalization and increased mortality. Early detection of bacterial sepsis is critical; however, distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis. Conventional sepsis biomarkers, such as procalcitonin and C-reactive protein, have shown limited utility in LF patients due to inconsistent results. In contrast, novel biomarkers like presepsin and sTREM-1 have demonstrated promising discriminatory performance in this population, pending further validation. Moreover, emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization. Although preliminary findings are encouraging, further studies are necessary to validate these results across diverse patient cohorts, including those with LF. This article provides a comprehensive review of the magnitude, impact, and diagnostic challenges associated with BI in LF patients, focusing on novel advancements in early sepsis detection and characterization.
Core Tip: Patients with liver failure (LF) are prone to bacterial sepsis due to immune dysregulation. Up to 80% of such patients develop bacterial infection, which is associated with various complications and poor outcomes. Therefore, it is imperative to diagnose bacterial sepsis at the earliest. However, differentiating between patients with and without sepsis can be challenging, as LF itself can mimic sepsis by inducing systemic inflammation and organ failure. Several novel biomarkers for sepsis and machine learning techniques are being investigated, as conventional biomarkers have shown inconsistent results in LF patients. This article addresses the magnitude, impact, challenges, and recent developments in understanding bacterial sepsis in LF patients.
