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Infections in acute liver failure - Assessment, prevention, and management
Guhan Venkatakrishnan1, Binoj S Pillai Thankamony Amma1, Ramachandran N Menon1
1Department of Gastrointestinal Surgery and Solid Organ Transplant, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India.
Best Practice & Research. Clinical Gastroenterology
|December 21, 2024
Summary
Infections significantly worsen outcomes in acute liver failure (ALF), necessitating prompt diagnosis and management. This review covers common infections, diagnostic methods, and treatment strategies for ALF patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infections are a major complication in acute liver failure (ALF), increasing morbidity, mortality, and hindering liver transplantation.
- Bacterial infections account for two-thirds of ALF infections, with fungal infections comprising the remaining third.
- Multi-drug resistant (MDR) infections are common in ALF patients, particularly with prolonged intensive care unit (ICU) stays and invasive procedures.
Purpose of the Study:
- To review common infections in ALF patients.
- To discuss early diagnostic methods for infections in ALF.
- To outline recommended prophylactic, pre-emptive, and therapeutic strategies for managing infections in ALF.
Main Methods:
- Literature review of common infections in acute liver failure.
- Discussion of diagnostic markers including CRP, procalcitonin, 1,3-beta-D glucan, and galactomannan.
- Emphasis on blood cultures and respiratory cultures (BAL/mini-BAL) as gold standards for diagnosis.
Main Results:
- High suspicion for infection is critical upon clinical deterioration in ALF.
- Nosocomial infections are prevalent, underscoring the importance of ICU infection control practices.
- Effective management involves early diagnosis and tailored antimicrobial or antifungal therapy.
Conclusions:
- Prompt identification and treatment of infections are crucial for improving outcomes in ALF.
- Prevention through stringent infection control measures in the ICU is paramount.
- A multi-faceted approach combining diagnostics and evidence-based therapies is essential for managing ALF-associated infections.
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