Current evidence on septic shock in patients with cirrhosis

PURPOSE OF REVIEW: This review aims to synthetize current evidence on the management of septic shock in patients with cirrhosis. It highlights the unique characteristics and the limitations of conventional strategies in this population. RECENT FINDINGS: The distinct pathophysiological profile of septic shock in patients with cirrhosis and different endothelial dysfunction phenotypes were explored in recent studies. Hemodynamic targets and resuscitation strategies may need to be adjusted in this population, but no definitive parameters have been identified. Trials evaluating fluid therapy have shown mixed results regarding the use of albumin, with no clear long-term survival benefit over crystalloids. Prognostic tools incorporating dynamic assessments are gaining traction but require further validation. SUMMARY: Septic shock in patients with cirrhosis presents unique diagnostic and therapeutic challenges due to underlying hemodynamic changes and immune dysfunction. Conventional approaches to sepsis management may be insufficient or unreliable in this population, necessitating tailored strategies for fluid resuscitation and vasopressor use. High-quality evidence remains limited, and many current practices are based on extrapolation from the general population. Continued research is essential to develop targeted interventions and improve outcomes for this particularly vulnerable group.