Figure 3.

Bacterial infections are common in cirrhosis and precipitate complications. Bacterial infections in cirrhosis exacerbate existing systemic inflammation which impairs left ventricular function and reduces splanchnic and systemic circulation vascular resistance. This leads to acute decompensation and ACLF. The CARS develops in acute decompensation and ACLF to minimize the effects of the intense proinflammatory response. The CARS induces immunoparesis through a number of mechanisms; levels of circulating anti-inflammatory cytokines increase, monocytes exhibit features of defective anti-bacterial function and a range of neutrophil functions are impaired. The resultant immunoparesis thus impairs the host response to pathogens and predisposes patients with cirrhosis to infection. Created with biorender.com. ACLF, acute-on-chronic liver failure; CARS, compensatory anti-inflammatory response syndrome; LV, left ventricle.