Can a patient with cirrhosis (liver scarring) present with fever?

From the Guidelines

Yes, patients with cirrhosis can present with fever, which is a concerning symptom that requires prompt medical evaluation as it often indicates infection, which can be life-threatening in this population. Fever in cirrhotic patients can be caused by various infections, including spontaneous bacterial peritonitis, urinary tract infections, pneumonia, and cellulitis, as well as alcoholic hepatitis, which can occur alongside cirrhosis even without infection 1. Cirrhosis impairs immune function through multiple mechanisms, making patients more susceptible to infections. When a cirrhotic patient develops fever, immediate medical attention is necessary, typically including:

• Blood cultures
• Ascitic fluid analysis (if ascites is present)
• Urinalysis
• Chest imaging Empiric antibiotic therapy may be initiated while awaiting culture results, often with third-generation cephalosporins or fluoroquinolones depending on the suspected source of infection and local resistance patterns 1. It is essential to note that the presentation of infection in cirrhotic patients can be subtle, and a high level of suspicion for sepsis is needed in all patients with cirrhosis who present to the emergency room 1.

From the Research

Presentation of Fever in Cirrhosis

• Fever can be a presenting symptom in patients with cirrhosis, as evidenced by various studies 2, 3, 4, 5, 6.
• The presence of fever in cirrhosis can be due to several causes, including:
  • Spontaneous bacterial peritonitis (SBP), a common complication in patients with cirrhosis and ascites 2, 3, 4, 5.
  • Infections, which are more frequent in patients with cirrhosis due to impaired host defenses 6.
  • Alcoholic hepatitis, which can present with fever, jaundice, and hepatomegaly 6.
  • Other causes, such as hepatoma or endotoxemia 6.

Clinical Features of Fever in Cirrhosis

• The clinical features of fever in cirrhosis can vary, but common presenting symptoms include:
  • Abdominal pain and fever, noted in 57% and 54% of patients with SBP, respectively 4.
  • Ascites, which is a common complication in patients with cirrhosis and can be associated with SBP 2, 3, 4, 5.
  • Jaundice, hepatomegaly, and leukocytosis, which can be present in patients with alcoholic hepatitis 6.

Diagnosis and Treatment of Fever in Cirrhosis

• The diagnosis of fever in cirrhosis requires a thorough evaluation, including:
  • Diagnostic paracentesis to rule out SBP 5.
  • Blood cultures and other laboratory tests to identify the cause of fever 2, 3, 4, 5, 6.
• The treatment of fever in cirrhosis depends on the underlying cause, but may include:
  • Antibiotics for SBP or other infections 2, 3, 4, 5.
  • Supportive care, such as fluid resuscitation and pain management, for patients with cirrhosis and fever 2, 3, 4, 5, 6.