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Cirrhotic Multiorgan Syndrome

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Abstract

Patients with cirrhosis and portal hypertension are at an increased risk of the development of circulatory dysfunction that may potentially result in multiple organ failure. Apart from the liver, this may involve the heart, lungs, kidneys, the immune system, the adrenal glands, and other organ systems. As the disease progresses, the circulation becomes hyperdynamic, and signs of cardiac, pulmonary, and renal dysfunction are observed, in addition to reduced survival. Infections and an altered cardiac function known as cirrhotic cardiomyopathy may be precipitators for the development of other complications such as hepatorenal syndrome. In patients with chronic organ dysfunction, various precipitating events may induce an acute-on-chronic renal failure and acute-on-chronic liver failure that negatively affect the prognosis. Future research on the pathophysiologic mechanisms of the complications and the precipitating factors is essential to understand the basics of the treatment of these challenging conditions. The aim of the present review is to focus on the development and precipitating factors of various organ failures in patients with decompensated cirrhosis.

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Abbreviations

ACLF:

Acute-on-chronic liver failure

AKI:

Acute kidney injury

BRS:

Baroreflex sensitivity

CCK:

Cholecystokinin

CCM:

Cirrhotic cardiomyopathy

CEE:

Contrast-enhanced echocardiography

CGRP:

Calcitonin gene-related peptide

CKD:

Chronic kidney disease

CRP:

C-reactive protein

ET:

Endothelin

GFR:

Glomerular filtration rate

HPS:

Hepatopulmonary syndrome

HRS:

Hepatorenal syndrome

IL:

Interleukin

mIBG:

Metaiodobenzyl-guanidine

eNOS:

Endothelial nitric oxide synthase

PAa,O2 :

Alveolar-arterial oxygen gradient

PET:

Positron emission tomography

PoPH:

Portopulmonary hypertension

RAI:

Relative adrenal insufficiency

SBP:

Spontaneous bacterial peritonitis

SIRS:

Systemic inflammatory response syndrome

TIPS:

Transjugular portosystemic shunt

TNF:

Tumor necrosis factor

VEGF:

Vascular endothelial growth factor

VIP:

Vasoactive intestinal polypeptide

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Acknowledgments

Professor Søren Møller was supported by a grant from the Novo Nordisk Foundation and The University of Copenhagen.

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The authors declare that they have no conflict of interest.

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  1. Center for Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Faculty of Health Sciences, Copenhagen University Hvidovre Hospital, Kettegaard alle 30, 2650, Hvidovre, Denmark

    Søren Møller

  2. Gastro Unit, Medical Division, Faculty of Health Sciences, Copenhagen University Hvidovre Hospital, Kettegaard alle 30, 2650, Hvidovre, Denmark

    Flemming Bendtsen

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Møller, S., Bendtsen, F. Cirrhotic Multiorgan Syndrome. Dig Dis Sci 60, 3209–3225 (2015). https://doi.org/10.1007/s10620-015-3752-3

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