Bakterielle und virale Infektionen als Auslöser eines akut-auf-chronischen Leberversagens

Patients with liver cirrhosis are susceptible to infection, the most frequent trigger of acute decompensation (AD) and acute-on-chronic liver failure (ACLF). Infections in ACLF are independently associated with increased mortality. The role of viral infection precipitating AD or ACLF has been underestimated and is nowadays increasingly assessed systematically. As most ACLFs are accompanied by systemic inflammation irrespective of etiology, differentiating between sterile ACLF and infection/sepsis may prove challenging in daily clinical routine. If infections are suspected, early broad-spectrum antibiotic therapy is warranted, as multidrug-resistant organisms (MDRO) causing infections are commonly described in patients with decompensated liver disease (20–30% in Europe). Local resistance profile and individual risk for MDRO should be considered when choosing initial therapy. Adequate therapy and prevention of infections are able to reduce the risk of ACLF development and overall morality in patients with liver cirrhosis.