Sepsis, a life-threatening condition caused by the body’s dysregulated response to infection, can have a significant impact on the liver. The liver plays a crucial role in sepsis, acting as both a guardian and a target of the disease. While the liver’s immune response is responsible for clearing bacteria and toxins, it can also cause inflammation, immunosuppression, and organ damage.
The Liver’s Role in Sepsis
During sepsis, the liver switches from a tolerogenic to an immunogenic state, initiating the production of acute-phase proteins and contributing to the body’s defense against microbial infection. However, this protective response can also lead to liver injury, particularly in patients with liver cirrhosis, who are at a higher risk of bacterial translocation from the gut and impaired microbial defense.
Sepsis-induced liver injury can manifest in various forms, including hypoxic hepatitis due to ischemia and shock, sepsis-induced cholestasis due to altered bile metabolism, and hepatocellular injury due to drug toxicity or overwhelming inflammation. In critically ill patients, distinct pathologies such as secondary sclerosing cholangitis can also occur.
Recovery and Treatment
The recovery of the liver from sepsis depends on several factors, including the severity of the infection, the extent of liver damage, and the presence of underlying liver conditions. In some cases, the liver may be able to regenerate and recover its function, while in others, the damage may be irreversible.
Treatment for sepsis-induced liver injury focuses on treating the underlying infection and supporting the liver’s function. This may include avoiding potentially hepatotoxic drugs, providing early enteral feeding, monitoring glucose levels, and using extracorporeal liver support systems such as the Molecular Adsorbent Recirculating System (MARS) or single-pass albumin dialysis (SPAD).
Despite recent advances in treatment, sepsis remains a significant cause of mortality, with liver dysfunction serving as a powerful independent predictor of mortality in the intensive care unit. Attenuating liver injury and restoring the balance of liver pro-inflammatory and anti-inflammatory responses is crucial for lowering sepsis morbidity and mortality rates.