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Infections worsen prognosis of patients with cirrhosis irrespective of the liver disease stage

Published:September 14, 2017DOI:https://doi.org/10.1016/j.ejim.2017.09.014
      Cirrhosis is the end stage of various diseases of the liver. The leading causes of liver diseases are hepatitis B and C viral infections (HBV and HCV), alcohol consumption and cryptogenetic disease [
      • Ge P.S.
      • Runyon B.A.
      Treatment of patients with cirrhosis.
      ]. Thanks to the advent of nucleot(s)ide HBV analogs and direct anti HCV agents, the long-term survival of patients affected by liver cirrhosis has improved significantly in recent years [
      • Lampertico P.
      • Maini M.
      • Papatheodoridis G.
      Optimal management of hepatitis B virus infection – EASL special conference.
      ,
      • Gentile I.
      • Buonomo A.R.
      • Zappulo E.
      • Borgia G.
      Interferon-free therapies for chronic hepatitis C: toward a hepatitis C virus-free world?.
      ,
      • Gentile I.
      • Maraolo A.E.
      • Buonomo A.R.
      • Zappulo E.
      • Borgia G.
      The discovery of sofosbuvir: a revolution for therapy of chronic hepatitis C.
      ]. Nevertheless, even in case of viral suppression or viral clearance, patients with liver cirrhosis remain at risk for decompensation, hepatocellular carcinoma (HCC) and death. The more advanced the disease before antiviral-therapy, the higher the risk of complications or death [
      • Sievert W.
      • Razavi H.
      • Estes C.
      • Thompson A.J.
      • Zekry A.
      • Roberts S.K.
      • et al.
      Enhanced antiviral treatment efficacy and uptake in preventing the rising burden of hepatitis C-related liver disease and costs in Australia.
      ]. This finding prompted studies of the factors associated with a reduced survival rate in patients with cirrhosis and end-stage liver disease.

      Abbreviations:

      HCC (hepatocellular carcinoma), SBP (spontaneous bacterial peritonitis), PPI (proton-pump inhibitor), CRP (C reactive protein), CKD (chronic kidney disease), AKI (acute kidney injury), MELD (Model for End-Stage Liver Disease)
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