Therapeutic Conundrums in Cirrhosis: Need for a Paradigm Shift in Diagnostic Strategies

Bonus CE Session Moderator(s)

• 

  Aanchal Kapoor, MD (she/her/hers)

  Critical Care Specialist
  Cleveland Clinic Foundation
  Cleveland, Ohio

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.

Presentations:

• Complexity of Hemodynamic Assessment During Shock in Cirrhosis
• Acute Kidney Injury in Cirrhosis: Think Broadly and Exclude Other Causes Before Anchoring to Hepatorenal Syndrome
• Cirrhosis-Associated Immune Dysfunction and Potential for Late Identification of Sepsis