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Dekompensierte Leberzirrhose und akut-auf-chronisches Leberversagen

  • C. Engelmann
  • F. TackeEmail author
Schwerpunkt
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Zusammenfassung

Patienten mit Leberzirrhose, die auf der Intensivstation behandelt werden, haben eine hohe Letalität. Man unterscheidet die dekompensierte Leberzirrhose, d. h. typische Komplikationen der Zirrhose, wie Ösophagusvarizenblutung, hepatische Enzephalopathie, hepatorenales Syndrom oder Aszites, vom akut-auf-chronischen Leberversagen (ACLF), bei dem begleitend zur vorbestehenden chronischen Lebererkrankung ein oder mehrere Organversagen vorliegen. In beiden Fällen ist ein strukturiertes intensivmedizinisches Management zur zielgerechten Behandlung der Ursachen der Dekompensation (z. B. Blutungen, Infektionen, Exsikkose, Medikamente) und der begleitenden Organversagen (z. B. Nierenversagen, Enzephalopathie) essenziell. Für Organversagen sind Kriterien definiert, die die Diagnose eines ACLF ermöglichen. Eine besondere Bedeutung kommt der schnellen und adäquaten (antibiotischen und antimykotischen) Infekttherapie zu. Für typische Komplikationen der Leberzirrhose, wie Nierenversagen/hepatorenales Syndrom, hepatische Enzephalopathie, Aszites oder Varizenblutungen, existieren klare Behandlungspfade. Bei ACLF oder dekompensierter Leberzirrhose sollte immer die Möglichkeit einer Lebertransplantation bedacht und im interdisziplinären Team diskutiert werden. Neue Behandlungsansätze beim ACLF adressieren in klinischen Studien Mechanismen der Inflammation, Immunantwort und Regeneration.

Schlüsselwörter

Multiples Organversagen Intensivmedizin Regeneration Infektionen Angeborene und erworbene Immunität 

Decompensated liver cirrhosis and acute-on-chronic liver failure

Abstract

Patients with liver cirrhosis who require treatment in an intensive care unit (ICU) have a high mortality rate. It is important to distinguish decompensated liver cirrhosis with typical disease-associated complications (e.g., esophageal variceal bleeding, hepatic encephalopathy, hepatorenal syndrome or ascites) from acute-on-chronic liver failure (ACLF), in which single or multiple organ failure rapidly develops on top of a pre-existing decompensated chronic liver disease. Organ failure is clearly defined by the CLIF‑C organ failure (OF) score. In both decompensated cirrhosis and ACLF, structured ICU management that includes the treatment of precipitating events (e.g., bleeding, infections volume depletion, medication) and concomitant organ failure (e.g., renal failure, encephalopathy) is essential. Of particular importance is rapid and adequate (antibiotic and antifungal) infectious therapy, and clear treatment algorithms exist for cirrhosis-associated complications such as renal failure/hepatorenal syndrome, hepatic encephalopathy, ascites or variceal bleeding. The possibility of liver transplantation should always be part of an interdisciplinary discussion about individual therapeutic strategies. New treatment approaches for ACLF address mechanisms of inflammation, immune response, and regeneration in clinical trials.

Keywords

Multiple organ failure Intensive care Regeneration Infections Innate and adaptive immunity 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Engelmann erhielt Forschungsgelder sowie Reisekostenunterstützung von Novartis, Sequana Medical und Merz Pharmaceuticals und wurde durch Gelder der Deutschen Forschungsgemeinschaft (DFG) finanziert. F. Tacke hat Forschungsgelder von Galapagos, Allergan, Bristol-Myers Squibb und Inventiva erhalten.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020

Authors and Affiliations

  1. 1.Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM)Charité Universitätsmedizin BerlinBerlinDeutschland
  2. 2.Institute for Liver and Digestive HealthUniversity College London, Royal Free CampusLondonDeutschland
  3. 3.Sektion Hepatologie, Klinik für Gastroenterologie und RheumatologieUniversitätsklinik LeipzigLeipzigDeutschland

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