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

Bacterial and viral infections as triggers of acute-on-chronic liver failure

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Zusammenfassung

Patienten mit Leberzirrhose haben eine deutlich erhöhte Suszeptibilität für Infektionen. Bakterielle Infektionen sind der häufigste Auslöser für eine akute Dekompensation (AD) und ein akut-auf-chronisches Leberversagen (ACLF). Das Vorliegen einer Infektion geht dabei unabhängig vom ACLF selbst mit einer erhöhten Mortalität einher. Die Relevanz von viralen Infektionen als Auslöser einer AD oder eines ACLF wurde bis vor kurzen vermutlich unterschätzt, wird jedoch zunehmend systematisch untersucht. Da viele Patienten mit ACLF auch unabhängig von Infektionen eine relevante systemische Inflammation aufweisen, ist eine initiale Differenzierung in der Praxis zu anderen Auslösern oft herausfordernd. Bei vermuteter Infektion und im Zweifelsfall sollte insbesondere bei kritisch kranken Patienten eine rasche empirische antiinfektive Therapie mit Breitspektrumantibiotika eingeleitet werden, da multiresistente Erreger (MRE) je nach Region in Europa für bis zu 20–30 % der Infektionen verantwortlich sind. Die lokale Resistenzlage und patientenindividuelle Risikofaktoren für das Vorliegen von MRE sollten bei der Wahl der Antibiotika berücksichtigt werden. Eine adäquate Therapie und geeignete Maßnahmen zur Infektprävention können die Entstehung eines ACLF reduzieren und die Mortalität bei Patienten mit Leberzirrhose nachweislich senken.

Abstract

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.

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  1. Medizinische Klinik 1, Universitätsklinikum, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    Marcus M. Mücke

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Correspondence to Marcus M. Mücke.

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Tony Bruns, Aachen

Christian Lange, München

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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Mücke, M.M. Bakterielle und virale Infektionen als Auslöser eines akut-auf-chronischen Leberversagens. Gastroenterologie (2024). https://doi.org/10.1007/s11377-024-00783-x

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  • DOI: https://doi.org/10.1007/s11377-024-00783-x

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