From the Research
Yes, patients with acute liver failure can develop leukocytosis, as evidenced by the most recent study in 2020 1. Leukocytosis in acute liver failure typically occurs due to the systemic inflammatory response triggered by the liver injury. The damaged liver releases inflammatory mediators that stimulate bone marrow production of white blood cells. Additionally, bacterial infections are common complications in acute liver failure patients due to their compromised immune function and increased intestinal permeability, which can further elevate white blood cell counts. Some key points to consider include:
- Bacterial infections are a frequent trigger of acute-on-chronic liver failure, with a high prevalence of infections in these patients 2, 3.
- The presence of infection is associated with higher mortality in patients with acute liver failure 2, 3.
- Sterile inflammation from massive hepatocyte death can also contribute to leukocytosis even in the absence of infection 1. Clinicians should be aware that while leukocytosis may indicate infection requiring antibiotic treatment, it can also simply reflect the inflammatory state of acute liver failure itself. When evaluating a patient with acute liver failure who has an elevated white blood cell count, it's essential to perform a thorough infection workup, including:
- Blood cultures
- Urinalysis
- Chest imaging
- Ascitic fluid analysis if ascites is present as distinguishing between infection-related and non-infection-related leukocytosis is crucial for appropriate management 4, 5.