Volume 152, Issue 5, Pages 938-940 (April 2017) Infection in Severe Alcoholic Hepatitis: Yet Another Piece in the Puzzle  Ashwani K. Singal  Gastroenterology  Volume 152, Issue 5, Pages 938-940 (April 2017) DOI: 10.1053/j.gastro.2017.02.030 Copyright © 2017 AGA Institute Terms and Conditions

Figure 1 Key events in severe alcoholic hepatitis that lead to multiple organ dysfunction. Bacterial translocation results from intestinal dysbiosis and increased small bowel permeability and is detected by circulating bacterial DNA. Systemic inflammatory response syndrome (SIRS) and bacteremia are consequences of bacterial translocation. Prednisolone tips the balance between SIRS and compensatory antiinflammatory response syndrome (CARS) toward CARS, which then results in immune paralysis, nosocomial infections, and multiple organ dysfunction. Gastroenterology 2017 152, 938-940DOI: (10.1053/j.gastro.2017.02.030) Copyright © 2017 AGA Institute Terms and Conditions