Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance

Area of Science:

• Hepatology
• Immunology
• Internal Medicine

Background:

• Cirrhosis leads to immune dysfunction, characterized by immunodeficiency and systemic inflammation.
• This dysfunction increases susceptibility to bacterial infections, a key feature of advanced cirrhosis.
• The liver's immune-regulating functions are compromised in cirrhosis, affecting systemic immune responses.

Purpose of the Study:

• To describe cirrhosis-associated immune dysfunction (CAID).
• To explain the pathophysiological mechanisms underlying CAID.
• To outline the spectrum of CAID phenotypes in relation to cirrhosis severity.

Main Methods:

• Review of existing literature on cirrhosis and immune function.
• Analysis of the pathophysiological consequences of liver damage on the immune system.
• Description of the dynamic shifts in immune phenotypes during cirrhosis progression.

Main Results:

• CAID encompasses both immunodeficiency and systemic inflammation.
• Impaired reticulo-endothelial system function and reduced hepatic protein synthesis contribute to immune deficits.
• Systemic inflammation arises from liver cell damage and gut permeability, activating immune cells and increasing pro-inflammatory cytokines.

Conclusions:

• CAID phenotypes range from predominantly pro-inflammatory in stable cirrhosis to predominantly immunodeficient in severe decompensation.
• These phenotypes represent dynamic, reversible states within the spectrum of cirrhosis.
• Systemic inflammation in cirrhosis exacerbates disease manifestations, such as hemodynamic derangement, and negatively impacts prognosis.