Résumé
La cirrhose et la consommation excessive d’alcool s’accompagnent de modifications de l’immunité acquise et innée, qui prédisposent au développement de pneumonies graves, le plus souvent bactériennes, mais aussi virales ou fongiques. L’infection pulmonaire peut être l’élément déclenchant d’un « syndrome d’insuffisance hépatocellulaire aiguë surchronique », dont la mortalité à court terme est élevée. Le diagnostic d’infection pulmonaire est plus complexe et la documentation microbiologique plus rare chez le patient cirrhotique que chez le patient non cirrhotique. La prise en charge thérapeutique repose sur un traitement anti-infectieux précoce et adapté, ainsi que sur la prévention des défaillances d’organes, en particulier de l’insuffisance rénale. Si le pronostic des patients cirrhotiques avec choc septique pris en charge en réanimation s’est amélioré au cours des dernières années, la mortalité de ces patients reste cependant encore élevée. Au décours d’une infection pulmonaire grave, le pronostic des patients cirrhotiques décompensés est médiocre à court terme. Le patient doit alors être orienté vers un projet de greffe.
Abstract
Cirrhosis, due to excessive alcohol consumption, is associated with innate and adaptive immune dysfunctions, which predispose to the development of severe bacterial, viral but also fungal pneumonia. Pulmonary infection can trigger an acute-on-chronic-liver failure, a syndrome associated with high short-term mortality. The management of affected patients requires a prompt and appropriate antimicrobial therapy associated with the prevention of organ failures, especially renal failure. The intensive care unit (ICU) outcome of patients with cirrhosis and septic shock has improved over time but still remains high. Liver transplantation should be considered in patients with decompensated cirrhosis following severe pulmonary infection.
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Gacouin, A., Tadié, JM. & Le Tulzo, Y. Infections bronchopulmonaires chez le patient cirrhotique. Réanimation 24, 236–248 (2015). https://doi.org/10.1007/s13546-015-1046-6
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DOI: https://doi.org/10.1007/s13546-015-1046-6