Patients with decompensated cirrhosis have a tendency to develop bacterial infections due to dysfunction at different levels of the immune response, leading to acute exacerbation of the disease, in which about one third of patients develop [acute-on-chronic liver failure (ACLF)]. ACLF syndrome is a high mortality disease. In addition, bacterial infections also worsen long-term outcomes and are considered an important aggravating factor in the course of the disease. Bacterial translocation (BT) is a crucial mechanism for the development of infections. Impairment of intestinal barrier function worsens as the disease progresses and during the acute episode of decompensation, bacteria and immunologically active bacterial products enter the circulation and contribute to the development of multiple organ failure, or ACLF. At the same time, the systemic inflammatory response (SIRS), through the damaging effect of inflammatory cytokines on intestinal epithelial cells, impairs the intestinal barrier function and thus enhances BT. Early and effective diagnosis and reliable prediction of bacterial infections in cirrhosis of the liver are key to controlling complications, slowing progression, and reducing mortality.
Prospective follow-up and progression of bacterial infections, as well as a better understanding of the cirrhosis-associated immune-dysfunction (CAID) syndrome provide insight into the details of altered defenses against bacterial infections, allowing the clinical significance of each sub-process to be explored. This may, on the one hand, facilitate the design of new non-antibiotic supportive treatments. In the advanced stage of disease, when improvement of liver function is no longer possible without liver transplantation, correction of CAID components may reduce the incidence of emerging and predominantly fatal infections and thus contribute to improved waiting list survival. On the other hand, it enables everyday clinical practice to introduce new biomarkers that enable reliable prediction of infectious episodes. This will help to select the patient group most at risk for infections, which should be followed closely and given supportive care and / or prophylactic antibiotic therapy. The importance of more effective antibiotic prophylaxis design in cirrhosis of the liver is underlined by the growing problem of bacterial resistance.
Long-term prospective monitoring of the development and course of decompensated cirrhosis of the liver and its associated biobank, and the identification of serologic factors that reliably reflect CAID syndrome and the risk of congenital genetic, more effective antibiotic prophylaxis planning, and the development of new non-antibiotic-based supportive treatments for cirrhosis of the liver.