Despite major advances in the knowledge and management of liver diseases achieved in recent decades,decompensation of cirrhosis still carries a high burden of morbidity and mortality.Bacterial infections are one of th...Despite major advances in the knowledge and management of liver diseases achieved in recent decades,decompensation of cirrhosis still carries a high burden of morbidity and mortality.Bacterial infections are one of the main causes of decompensation.It is very important for clinical management to be aware of the population with the highest risk of poor outcome.This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently.Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines.Moreover,it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and,in infected patients,with the degree of sepsis.It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection,severe sepsis,hepatorenal syndrome and death.We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.展开更多
1.Introduction Regular exercise induces changes in the overall diversity and in the relative abundance of certain gut microbiota phyla and families in humans1,2 and in animal models.3,4 This relationship has attracted...1.Introduction Regular exercise induces changes in the overall diversity and in the relative abundance of certain gut microbiota phyla and families in humans1,2 and in animal models.3,4 This relationship has attracted a great deal of interest because it is one of the mechanisms involved in the health benefits of regular exercise3 that could also influence performance.5 A recent publication by Scheiman et al.展开更多
文摘Despite major advances in the knowledge and management of liver diseases achieved in recent decades,decompensation of cirrhosis still carries a high burden of morbidity and mortality.Bacterial infections are one of the main causes of decompensation.It is very important for clinical management to be aware of the population with the highest risk of poor outcome.This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently.Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines.Moreover,it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and,in infected patients,with the degree of sepsis.It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection,severe sepsis,hepatorenal syndrome and death.We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.
基金supported by Ministerio de Economíay Competitividad under Grant DEP2015-69980-P to BFGPrograma de Ayudas a Grupos de Investigación del Principado de Asturias to FLB(FC-GRUPIN-IDI/2018/000120)。
文摘1.Introduction Regular exercise induces changes in the overall diversity and in the relative abundance of certain gut microbiota phyla and families in humans1,2 and in animal models.3,4 This relationship has attracted a great deal of interest because it is one of the mechanisms involved in the health benefits of regular exercise3 that could also influence performance.5 A recent publication by Scheiman et al.
