Biography
Biography: Alaaeldin Ibrahim
Abstract
The word sepsis comes from Greek meaning ‘decay’ or ‘to putrefy’. Sepsis is an aftermath of the host micro-organism interaction. This interaction progresses through various levels, to ultimately culminate into multiple organ dysfunction syndrome. Systemic inflammatory response is the initial response to invasion by microorganism. The step wise progression includes infection by an organism, induction of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock and finally, multiple organ system dysfunction. The annual incidence of sepsis is 300 in 100000 patients or 1 in 100 hospital admission for any cause. In cirrhosis, sepsis is present in 30 to 50% of hospital admissions. In hospital, 15 to 35% of cirrhosis patients develop nosocomial sepsis in comparison to 5 to 7% seen with general population. Down-regulation of monocytic human leukocyte antigen DR expression (mHLA-DR), impairment in antigen presentation, lower complement levels and macrophage dysfunction due to weal Fc receptor mediated bacterial clearance all impair immunity in liver disease. It has been shown that neutrophilic phagocytic activity and intracellular killing is decreased in patients of cirrhosis. The most common bacterial infection in cirrhosis is spontaneous bacterial peritonitis 20%, bacteremia and soft tissue infections (11-12%). (SBP, 25-30%) followed by genitourinary infections (UTI, 20 to 25%), pneumonia (15-20%). Around three fourths of infections in cirrhosis are related to Gram negative bacteria. Sepsis in cirrhotics portend grave prognosis. Even as science has grown vastly and understanding of sepsis has broadened, the mortality associated with this condition in cirrhosis is still quite high. In this lecture, a comprehensive discussion on emerging concepts in pathogenesis of sepsis in the light of cirrhosis has been made. The diagnosis and current cutting edge management of this fatal condition and future treatment modalities are discussed, so as to entertain a holistic management in the critically ill cirrhotic.
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