Management of sepsis in patients with liver failure.
OBJECTIVE
Sepsis constitutes the most common cause of death in the ICU. Liver dysfunction is manifested among previously normal subjects with sepsis but even more so in populations with preexisting liver disease. Managing these patients is more challenging. We will review recent literature in sepsis and liver disease, and their bedside application.


RESULTS
At the cellular-chemical level, studies showed that platelet aggregation and neutrophil activation occur before and are independent of microcirculatory changes which are apparent in all animal septic models. At the clinical level, early goal-directed therapy, euglycemia, low tidal volume ventilation, and early and appropriately dosed renal replacement therapy among others are all tools to improve sepsis survival. Acknowledgement of liver disease as an immunocompromised host, and identification and treatment of complications can positively change the outcome of sepsis in liver disease.


CONCLUSIONS
Much has been advanced in the field of sepsis management. Understanding the pathophysiology of liver dysfunction and decompensation of a diseased liver incites questions for future research. Early goal-directed therapy, lactate clearance, glycemic control, low volume ventilation strategies, nutrition, adrenal insufficiency, renal dysfunction, hepatorenal syndrome prevention and treatment are some of the issues in the management of sepsis, with or without liver disease, that are relevant in this review.
Canabal
Juan M
JM
Transplant Critical Care, Mayo Clinic, Jacksonville, Florida 32224, USA. canabal.juan@mayo.edu
Kramer
David J
DJ
D003422:Critical Care; D005440:Fluid Therapy; D006801:Humans; D008103:Liver Cirrhosis; D017114:Liver Failure, Acute / Q000150:complications* / Q000628:therapy; D009752:Nutritional Status; D017582:Renal Replacement Therapy; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors