The systemic inflammatory response syndrome in cirrhotic patients: Relationship with their in-hospital outcome☆

Background/Aims

Some evidence suggests that the systemic inflammatory response syndrome (SIRS) contributes to the poor outcome of cirrhotic patients. We studied 141 cirrhotic patients consecutively admitted to a tertiary referral centre assessing prevalence of SIRS and its relationship with in-hospital outcome.

Methods

Presence of SIRS was assessed on admission and during hospital stay. Main clinical outcomes were death and development of portal hypertension-related complications.

Results

Thirty-nine patients met SIRS criteria. SIRS was present on admission in 20 of 141 patients (14.1%), whereas it occurred during hospital stay in 19 of 121 (15.7%). SIRS was correlated with bacterial infection at admission (p=0.02), jaundice (p=0.011), high serum creatinine levels (p=0.04), high serum bilirubin levels (p=0.002), high international normalized ratio (p=0.046), high model of end-stage liver disease (MELD) score (p=0.001), and high SOFA score (p=0.003). During a follow-up of 14±8 days, 16 patients died (11%), 7 developed portal hypertension-related bleeding (5%), 16 hepatic encephalopathy (11%), and 5 hepatorenal syndrome type-1 (3.5%). SIRS was correlated both to death (p<0.001) and to portal hypertension-related complications (p<0.001). On multivariate analysis, SIRS and MELD were independently associated with death.

Conclusions

SIRS frequently occurs in patients with advanced cirrhosis and is associated with a poor outcome.

Abbreviations: SIRS, systemic inflammatory response syndrome, HCC, hepatocellular carcinoma, SBP, spontaneous bacterial peritonitis, WBC, white blood cell, PMNCs, polymorphonuclear neutrophil cells, MELD, model of end-stage liver disease, HRS, hepatorenal syndrome, PRCs, packed red cells, ICU, intensive care unit, INR, international normalized ratio, TNF, tumor necrosis factor, PPV, positive predictive value, NPV, negative predicting value, LR, likelihood ratio

Keywords: Cirrhosis, Infection, Portal hypertension, Systemic inflammatory response syndrome, Survival