Critical Care Specialist Cleveland Clinic Foundation Cleveland, Ohio
Disclosure(s):
Aanchal Kapoor, MD: No relevant financial relationship(s) to disclose.
Liver injury and failure in critically ill patients have increased in recent decades. Up to 20% of ICU patients present with liver failure and have significantly increased morbidity and mortality. Sepsis, septic shock, acute kidney injury (AKI), and circulatory failure are the most frequent causes of high mortality in this patient population. Patients with cirrhosis have associated immune dysfunction, circulatory imbalances, and complex cross-organ interactions leading to multiorgan dysfunction depending on the stage, severity, and etiology of decompensation of cirrhosis. Hemodynamic perturbations, immune dysregulation, persistent systemic inflammation, increased blood volume, and hyperdynamic circulation in the background of portal hypertension pose significant diagnostic and therapeutic challenges for common ICU diagnoses such as septic shock, AKI, and identification of optimal left ventricular systolic function. A strategic approach to these diagnostic conundrums must be developed by encompassing the complex pathophysiologic and hemodynamic interactions and defining appropriate therapeutic interventions.
Learning Objectives:
Review cirrhosis-associated immune dysfunction and the potential for late identification of sepsis
Appraise pathophysiologic mechanisms during multiorgan interactions in cirrhosis
Describe the underlying mechanisms of acute kidney injury in cirrhosis
Predict left ventricular systolic function in the context of complex ventricular-arterial coupling
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