Infection and the progression of hepatic encephalopathy in acute liver failure

Division of Gastroenterology and Hepatology , Northwestern University, Evanston, Illinois, United States
Gastroenterology (Impact Factor: 13.93). 09/2003; 125(3):755-64. DOI: 10.1016/S0016-5085(03)01051-5
Source: PubMed

ABSTRACT Progression of hepatic encephalopathy (HE) is a major determinant of outcome in acute liver failure (ALF). Our aim was to identify predictive factors of worsening HE, including the relation of encephalopathy with the systemic inflammatory response (SIRS) and infection.
We included 227 consecutive patients with stage I-II HE prospectively enrolled in the U.S. Acute Liver Failure Study. Univariate and multivariate analysis of 27 variables at admission were performed separately for acetaminophen (n = 96) and nonacetaminophen (n = 131) etiologies.
On multivariate analysis, acquisition of infection during stage I-II HE (P < 0.01), increased leukocyte levels at admission (P < 0.01), and decreased platelet count (P < 0.05) were predictive factors of worsening HE in the acetaminophen group. By contrast, only increased pulse rate (P < 0.05) and AST levels (P < 0.05) at admission were predictors in nonacetaminophen patients. In patients who progressed to deep HE, the first confirmed infection preceded progression in 15 of 19 acetaminophen patients compared with 12 of 23 nonacetaminophen patients. In patients who did not demonstrate positive microbiologic cultures, a higher number of components of SIRS at admission was associated with more frequent worsening of HE (25% vs. 35% vs. 50% for 0, 1, and >or=2 components of SIRS, P < 0.05). CONCLUSIONA: This prospective evaluation points to infection and/or the resulting systemic inflammatory response as important factors contributing to worsening HE in ALF, mainly in patients with acetaminophen- induced ALF. The use of prophylactic antibiotics in these patients and the mechanisms by which infection triggers hepatic encephalopathy require further investigation.

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    ABSTRACT: The liver is often involved in systemic infections, resulting in various types of abnormal liver function test results. In particular, hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis, and several mechanisms for this phenomenon have been proposed. In this review, we summarize how the liver is involved in various systemic infections that are not considered to be primarily hepatotropic. In most patients with systemic infections, treatment for the invading microbes is enough to normalize the liver function tests. However, some patients may show severe liver injury or fulminant hepatic failure, requiring intensive treatment of the liver.
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    ABSTRACT: Background Many studies on T helper (Th) 1, Th2, T regulatory and Th17 cells have been carried out in acute-on-chronic liver failure (ACLF). However, CD8(+) T cell, as a main participant in immune-mediated injuries and defense against microorganisms, has seldom been studied in ACLF. Aims The purpose of this study was to investigate the CD8(+) T cell function, and the outcomes of patients with severe hepatitis [SH; serum bilirubin (SB) >= 10 mg/dl and prothrombin activity (PTA) <60 %]. Methods Thirty-six patients with chronic HBV-associated SH were included. Twenty normal chronic hepatitis B (CHB) patients (2 < SB < 10 (mg/dl) and PTA >= 60 %) and 28 healthy volunteers were enrolled as control groups. Results Twenty-six patients with SH were diagnosed with ACLF (SB >= 10 mg/dl and PTA <= 40 %). The non-recovered ACLFs (NR-ACLF) had higher HBV DNA loads than recovered ACLFs (R-ACLF) (6.03 +/- 1.79 vs. 4.36 +/- 1.61 (log(10,) IU/L)). The NR-ACLFs had the highest neutrophil: lymphocyte ratios (5.10 +/- 2.37) (all P < 0.001; a = 0.05). The CHBs had higher perforin(+) and T-CM (CD45RA(-)CD62L(hi)CCR7(+)) proportions [31.28 +/- 19.51, 5.32 +/- 3.57 (%)] compared to R-ACLFs (11.75 +/- 15.35, 0.78 +/- 0.76 (%); P = 0.004, 0.001, respectively), or NRACLFs (11.61 +/- 5.79, 1.14 +/- 0.67 (%); P = 0.006, 0.003). The non-ACLF SHs had higher CD38(+) proportions than R-ACLFs or NR-ACLFs (25.46 +/- 8.02 vs. 16.24 +/- 7.77 or 16.81 +/- 6.30 (%), P = 0.039, 0.023). Conclusions High neutrophil: lymphocyte ratios and a decrease in activated CD8(+) T cells may be related to poor outcomes in patients with SH.
    Digestive Diseases and Sciences 08/2014; 60(1). DOI:10.1007/s10620-014-3297-x · 2.26 Impact Factor


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May 29, 2014