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Review
. 2022 Aug 28;10(4):718-725.
doi: 10.14218/JCTH.2022.00024. Epub 2022 May 6.

Infections in Alcoholic Hepatitis

Bhupinder Kaur  1 , Russell Rosenblatt  2 , Vinay Sundaram  3
Affiliations
Review

Infections in Alcoholic Hepatitis

Bhupinder Kaur et al. J Clin Transl Hepatol. .

Abstract

Severe alcoholic hepatitis (sAH) is defined by a modified discriminant function ≥32 or model for end-stage liver disease (MELD) >20. Patients with sAH are in an immunocompromised state attributed to cirrhosis-related immunoparesis and corticosteroid use. Individuals with sAH often develop severe infections that adversely impact short-term prognosis. Currently, the corticosteroid prednisolone is the only treatment with proven efficacy in sAH; however, the combination of corticosteroid treatment and altered host defense in sAH has been thought to increase the risk of acquiring of bacterial, opportunistic fungal, and viral infections. Newer studies have shown that corticosteroids do not increase occurrence of infections in those with sAH; unfortunately, the lack of response to corticosteroids may instead predispose to infection development. Prompt and appropriate antibiotic treatment is therefore essential to improving patient outcomes. This review highlights common infections and risk factors in patients with sAH. Additionally, current diagnostic, therapeutic, and prophylactic strategies in these patients are discussed.

Keywords: Alcoholic hepatitis; Alcoholic liver disease; Antibiotic treatment; Aspergillosis; Corticosteroids; Immunodeficiency; Infections; STOPAH.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. Alcohol and the innate immune response.
Alcohol and its metabolite acetaldehyde alter tight junctions among epithelial cells, leading to increased gut permeability, allowing increased levels of lipopolysaccharide (LPS) to enter the portal circulation. LPS binds toll-like receptor (TLR) 4 and activates a cascade of cytokines and chemokines that lead to a state of both inflammation and immunosuppression. BP, binding protein; IFN, interferon; IL, interleukin; NF, nuclear factor; ROS, reactive oxygen species; TGF, transforming growth factor. Permission has been obtained for reproduction by source: Clinics in Liver Disease, Article: Infection and Alcoholic Liver Disease.
Fig. 2
Fig. 2. AH infection management.
CMV, cytomegalovirus; HBV, hepatitis B virus; HCV, hepatitis virus; HEV, hepatitis E virus.
See this image and copyright information in PMC

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