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Emerging concepts in the care of patients with cirrhosis and septic shock

Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general pop...

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Autores principales: Jimenez, Jose Victor, Garcia-Tsao, Guadalupe, Saffo, Saad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10190696/
https://www.ncbi.nlm.nih.gov/pubmed/37206653
http://dx.doi.org/10.4254/wjh.v15.i4.497
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author Jimenez, Jose Victor
Garcia-Tsao, Guadalupe
Saffo, Saad
author_facet Jimenez, Jose Victor
Garcia-Tsao, Guadalupe
Saffo, Saad
author_sort Jimenez, Jose Victor
collection PubMed
description Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.
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spelling pubmed-101906962023-05-18 Emerging concepts in the care of patients with cirrhosis and septic shock Jimenez, Jose Victor Garcia-Tsao, Guadalupe Saffo, Saad World J Hepatol Review Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly. Baishideng Publishing Group Inc 2023-04-27 2023-04-27 /pmc/articles/PMC10190696/ /pubmed/37206653 http://dx.doi.org/10.4254/wjh.v15.i4.497 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Review
Jimenez, Jose Victor
Garcia-Tsao, Guadalupe
Saffo, Saad
Emerging concepts in the care of patients with cirrhosis and septic shock
title Emerging concepts in the care of patients with cirrhosis and septic shock
title_full Emerging concepts in the care of patients with cirrhosis and septic shock
title_fullStr Emerging concepts in the care of patients with cirrhosis and septic shock
title_full_unstemmed Emerging concepts in the care of patients with cirrhosis and septic shock
title_short Emerging concepts in the care of patients with cirrhosis and septic shock
title_sort emerging concepts in the care of patients with cirrhosis and septic shock
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10190696/
https://www.ncbi.nlm.nih.gov/pubmed/37206653
http://dx.doi.org/10.4254/wjh.v15.i4.497
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