Difficult to treat infection in acute on chronic liver failure – Need for novel changes in traditional management

Acute on Chronic liver Failure (ACLF)

Abstract

Acute on chronic liver failure (ACLF) patients have inherent immunosuppressed state secondary to persistent endotoxemia and ongoing inflammatory state leading to high risk of developing infections, both de novo and nosocomial. The management of a critically ill patient with advanced liver disease and in severe sepsis has always been a challenge. Current approaches to management of sepsis rely on early antimicrobial use, fluid administration, hemodynamic maintenance and aggressive sepsis focus control. Even with current measures, the mortality from sepsis still remains very high, more so, in liver disease patients. The current report discusses briefly, a prototype of difficult to manage catastrophic infected ACLF patient with central nervous system infection leading to extensive vascular thrombosis of the brain leading to refractory septic shock and multi organ failure. We further discuss briefly on new management scenarios in severe sepsis in cirrhosis patients.