Mechanical factors diseases Disruption of the reticuloendothelial system leads to a diminished ability of the liver to clear pathogens from the portal venous system. Similarly, the altered intestinal motility, bacterial overgrowth, increased intestinal permeability, and bacterial translocation seen with spontaneous bacterial peritonitis may correlate with the bacterial translocation observed in multiorgan failure, sepsis, hemorrhagic shock, and surgical stress Viagra in Australia online. The explanation for the high incidence of respiratory infections is also likely to be multifactorial. Mechanical factors such as alterations in consciousness with diminished cough from encephalopathy or intoxication and restriction of basilar lung expansion from ascites may promote respiratory complications. However, abnormal respiratory cellular function has been demonstrated in studies of cirrhotic individuals, finding impaired cytokine release from stimulated alveolar macrophages, reduced alveolar macrophage phagocytic ability, and discordance between peripheral and alveolar T-lymphocyte subsets. Last, the treatment of serious infections must take into consideration the susceptibility of cirrhotic individuals to drug-related complications as a result of alterations in drug metabolism and clearance. One common drug-related complication is aminoglycoside nephrotoxicity, but coagulopathies and bleeding from broad-spectrum therapy with 3-lactam antibiotics also may occur.

Large national databases have been used to examine the epidemiology of sepsis and acute respiratory failure. TenHoor and colleagues analyzed the risk factors for ARDS using decedent data from the National Mortality Followback Study. Cirrhosis and sepsis were factors resulting in an increased proportional mortality ratio, which is a measure of the relative importance of an exposure to a specific cause of death. Patients with cirrhosis and sepsis were more likely to die with ARDS compared to individuals with ARDS who did not have cirrhosis or sepsis. Using national data, our study provides additional confirmation of the relative importance of infectious complications as a cause of death in patients with cirrhosis. Infectious etiologies (eg, septicemia and pneumonia) were listed as the primary hospital discharge diagnosis for 11.2% of the cirrhosis decedents. Other studies of sepsis have documented changing trends in epidemiology and have attempted to estimate the extent of its economic impact.