title: Liver - guardian, modifier and target of sepsis.
abstract: Sepsis and septic shock are characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection. The liver has a central role during sepsis, and is essential to the regulation of immune defence during systemic infections by mechanisms such as bacterial clearance, acute-phase protein or cytokine production and metabolic adaptation to inflammation. However, the liver is also a target for sepsis-related injury, including hypoxic hepatitis due to ischaemia and shock, cholestasis due to altered bile metabolism, hepatocellular injury due to drug toxicity or overwhelming inflammation, as well as distinct pathologies such as secondary sclerosing cholangitis in critically ill patients. Hence, hepatic dysfunction substantially impairs the prognosis of sepsis and serves as a powerful independent predictor of mortality in the intensive care unit. Sepsis is particularly problematic in patients with liver cirrhosis (who experience increased bacterial translocation from the gut and impaired microbial defence) as it can trigger acute-on-chronic liver failure - a syndrome with high short-term mortality. Here, we review the importance of the liver as a guardian, modifier and target of sepsis, the factors that contribute to sepsis in patients with liver cirrhosis and new therapeutic strategies.
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.|Interdisciplinary Center for Clinical Research, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Pavel
authors.initials: P
authors.lastname: Strnad
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Koch
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000209:etiology; D002779:Cholestasis / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000150:complications; D008099:Liver / Q000276:immunology* / Q000293:injuries; D008103:Liver Cirrhosis / Q000150:complications; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000276:immunology*
chemical_list: D000900:Anti-Bacterial Agents