title: Mechanisms of disease: mechanisms and clinical implications of cholestasis in sepsis.
abstract: Cholestasis is a common complication in patients with extrahepatic bacterial infection and sepsis. This article gives a comprehensive overview of the molecular and cellular mechanisms of sepsis-associated cholestasis. Recent advances in the understanding of intrahepatic cholestasis have allowed us to delineate the molecular mechanisms that underlie sepsis-associated cholestasis and to describe their potential clinical and therapeutic applications. The mechanisms and clinical presentation of sepsis-associated liver injury vary according to the severity of the bacterial infection. Proinflammatory cytokines and nitric oxide cause cholestasis by impairing hepatocellular and ductal bile formation. Ischemic liver injury and, rarely, progressive sclerosing cholangitis can also be found in patients with septic shock, or major trauma with systemic inflammatory response syndrome. Treatment is mainly focused on eradication of the underlying infection and managing the sepsis. The use of ursodeoxycholic acid or extracorporeal liver support as treatments for sepsis-associated cholestasis is under investigation, but neither can be recommended in routine clinical practice at present. Patients with progressive sclerosing cholangitis should be considered for orthotopic liver transplantation.
authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Aachen University, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Geier
authors.forename: Peter
authors.initials: P
authors.lastname: Fickert
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D001646:Bile / Q000378:metabolism; D001652:Bile Ducts / Q000503:physiopathology; D002779:Cholestasis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008107:Liver Diseases / Q000209:etiology / Q000628:therapy; D016031:Liver Transplantation; D009569:Nitric Oxide / Q000378:metabolism; D018805:Sepsis / Q000150:complications* / Q000628:therapy; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D016207:Cytokines; D009569:Nitric Oxide; D014580:Ursodeoxycholic Acid