Alcohol-related liver disease (ALD) remains the most important cause of death due to alcohol. Infections, particularly bacterial infections, are one of the most frequent and severe complications of advanced ALDs, such as alcoholic cirrhosis and severe alcoholic hepatitis (sAH). The specific mechanisms responsible for this altered host defence are yet to be deciphered. The aim of the present study is to review the current knowledge of infectious complications in ALD and its pathophysiological mechanisms, distinguishing the role of alcohol consumption and the contribution of different forms of ALD. To date, corticosteroids are the only treatment with proven efficacy in sAH, but their impact on the occurrence of infections remains controversial. The combination of an altered host defence and corticosteroid treatment in sAH has been suggested as a cause of opportunistic fungal and viral infections. A high level of suspicion with systematic screening and prompt, adequate treatment are warranted to improve outcomes in these patients. Prophylactic or preemptive strategies in this high-risk population might be a preferable option, because of the high short-term mortality rate despite adequate therapies. However, these strategies should be assessed in well-designed trials before clinical implementation.

中文翻译：

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酒精相关性肝病中的脓毒症

酒精相关性肝病 (ALD) 仍然是导致酒精死亡的最重要原因。感染，尤其是细菌感染，是晚期 ALD 最常见和最严重的并发症之一，例如酒精性肝硬化和严重酒精性肝炎 (sAH)。负责这种改变的宿主防御的具体机制尚未破译。本研究的目的是回顾目前对 ALD 感染并发症及其病理生理机制的认识，区分饮酒的作用和不同形式 ALD 的贡献。迄今为止，皮质类固醇是唯一经证实对 sAH 有效的治疗方法，但其对感染发生的影响仍存在争议。sAH 中宿主防御改变和皮质类固醇治疗的组合已被认为是机会性真菌和病毒感染的原因。需要高度怀疑并进行系统筛查和及时、充分的治疗，以改善这些患者的预后。在这一高危人群中采取预防性或先发制人的策略可能是更好的选择，因为尽管进行了充分的治疗，但短期死亡率仍然很高。然而，这些策略应该在临床实施之前在精心设计的试验中进行评估。因为尽管有足够的治疗，但短期死亡率仍然很高。然而，这些策略应该在临床实施之前在精心设计的试验中进行评估。因为尽管有足够的治疗，但短期死亡率仍然很高。然而，这些策略应该在临床实施之前在精心设计的试验中进行评估。