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Infections in severe alcoholic hepatitis.
Eleni Karakike1, Christophe Moreno2, Thierry Gustot3
1Department of Infectious Diseases, CHU Brugmann (Eleni Karakike).
Annals of Gastroenterology
|March 1, 2017
Summary
Severe alcoholic hepatitis (sAH) patients face high mortality, with infections being a primary cause of death. Early detection and treatment of infections are crucial for improving survival in sAH.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe alcoholic hepatitis (sAH) is a critical liver condition with a ~30% one-month mortality rate.
- Corticosteroids are the primary treatment for improving short-term survival in sAH.
- Infections complicate sAH in ~50% of patients, often leading to death despite corticosteroid therapy.
Purpose of the Study:
- To characterize infections in patients with severe alcoholic hepatitis.
- To identify risk factors and common pathogens associated with infections in sAH.
- To highlight the importance of infection screening and management in sAH.
Main Methods:
- Review of existing literature on infections in severe alcoholic hepatitis.
- Analysis of infection characteristics, including causative agents and affected sites.
- Identification of risk factors such as liver failure, recent alcohol consumption, and immunosuppression.
Main Results:
- Infections in sAH are predominantly bacterial, with respiratory tract infections being most common.
- Common pathogens include gram-negative bacilli, alongside opportunistic fungi (e.g., Aspergillus, Pneumocystis) and viruses (e.g., CMV, HSV), often linked to corticosteroid use.
- Risk factors for infection include liver failure, recent alcohol intake, and immunosuppressive medications.
Conclusions:
- Infections are a major cause of mortality in severe alcoholic hepatitis.
- Prompt and thorough infection screening, alongside adequate treatment, is essential for improving patient outcomes.
- Further research and well-designed trials are needed to evaluate prophylactic strategies for infection prevention in this high-risk group.
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