Infectious complications of acute and chronic liver disease

Semin Respir Crit Care Med. 2012 Feb;33(1):80-95. doi: 10.1055/s-0032-1301737. Epub 2012 Mar 23.


Acute and chronic liver diseases are frequently complicated by infections, which result in increased morbidity and mortality and place an economic burden on health care systems. This review discusses the epidemiology and the impact on prognosis of infections in liver cirrhosis, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, acute liver failure, and post-liver transplantation. Possible mechanisms for this increased susceptibility are innate immune dysfunction (Kupffer cells, neutrophils, monocytes), genetic predisposition, and intrinsic cellular defects. The causes for innate immune dysfunction may lie in increased gut permeability, the occurrence of endotoxemia, albumin and lipoprotein dysfunction, or toll-like receptor expression. From a clinical viewpoint this article discusses problems in diagnosing infection. Established (vaccination, antibiotic prophylaxis, antiviral prophylaxis, and nutrition) and experimental (probiotic) prophylactic strategies as well as established (antibiotics) and experimental (liver support, albumin, toll-like receptor antagonists) strategies are also reviewed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Community-Acquired Infections* / complications
  • Community-Acquired Infections* / diagnosis
  • Community-Acquired Infections* / drug therapy
  • Community-Acquired Infections* / prevention & control
  • Cross Infection* / complications
  • Cross Infection* / diagnosis
  • Cross Infection* / drug therapy
  • Cross Infection* / prevention & control
  • End Stage Liver Disease* / complications
  • End Stage Liver Disease* / economics
  • End Stage Liver Disease* / epidemiology
  • End Stage Liver Disease* / immunology
  • Fatty Liver / complications
  • Humans
  • Liver Cirrhosis* / complications
  • Liver Cirrhosis* / economics
  • Liver Cirrhosis* / epidemiology
  • Liver Cirrhosis* / immunology
  • Liver Failure, Acute* / complications
  • Liver Failure, Acute* / economics
  • Liver Failure, Acute* / epidemiology
  • Liver Failure, Acute* / immunology
  • Liver Transplantation / adverse effects*
  • Liver Transplantation / immunology
  • Liver, Artificial
  • Non-alcoholic Fatty Liver Disease
  • Prognosis
  • Severity of Illness Index


  • Anti-Bacterial Agents