Publication Name	World Journal of Hepatology
Manuscript ID	85035
Country	United Kingdom

Category	Gastroenterology & Hepatology
Manuscript Type	Systematic Reviews
Article Title	Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review
Manuscript Source	Invited Manuscript
All Author List	Nkola Ndomba and Jonathan Soldera
Funding Agency and Grant Number
Corresponding Author	Jonathan Soldera, MD, MSc, Associate Professor, Staff Physician, Acute Medicine, University of South Wales, University of South Wales, Cardiff CF37 1DL, United Kingdom, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Key Words	Sepsis; Septic shock; Cirrhosis; Sequential organ failure assessment score; Mean arterial pressure; Intensive care unit
Core Tip	Sepsis is a severe condition encountered in the intensive care unit (ICU), and when it occurs in cirrhotic patients, it often leads to high mortality due to impaired immunity and multiorgan failure. To diagnose and monitor sepsis in cirrhotic patients, various scoring systems have been developed, including the Sequential Organ Failure Assessment (SOFA) score, the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score, quick SOFA (qSOFA), Model for End-Stage Liver Disease (MELD), and MELD-Na score. Although the proposed current management of sepsis in cirrhotic patients might follow the guidelines proposed by the Surviving Sepsis Campaign, this approach has might not cause significant improvement in patient outcomes. Therefore, early recognition of infection and its source is critical, followed by timely initiation of antibiotic therapy, fluid resuscitation with albumin (5% or 20%), vasopressors, and low-dose corticosteroids such as hydrocortisone. Studies have shown that this approach reduces mortality in the ICU. In addition to pharmacological interventions, interventions to control the source of infection, such as surgical drainage, may also be necessary. Finally, procalcitonin levels can be used as a diagnostic biomarker in cirrhotic patients with sepsis, helping to guide antibiotic therapy and improve patient outcomes. In conclusion, timely recognition and management of sepsis in cirrhotic patients in the ICU is crucial, and early initiation of appropriate interventions, including antibiotics, fluids, and corticosteroids, may improve patient outcomes.
Citation	Ndomba N, Soldera J. Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review. World J Hepatol 2023; 15(6): 850-866

Received	2023-04-08 20:52
Peer-Review Started	2023-04-08 20:53
To Make the First Decision
Return for Revision	2023-05-04 17:18
Revised	2023-05-22 01:54
Second Decision	2023-05-31 03:10
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2023-05-31 08:02
Articles in Press	2023-05-31 08:02
Publication Fee Transferred
Edit the Manuscript by Language Editor
Typeset the Manuscript	2023-06-16 07:27

ISSN	1948-5182 (online)
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