Correlation between systemic inflammatory response syndrome and prognosis of patients with cirrhosis and hepatic...

Although systemic inflammatory response syndrome (SIRS) is associated with the progression of cirrhosis, its clinical significance in patients with cirrhosis and hepatic encephalopathy (HE) remains unclear.

Here, clinical data of 161 hospitalized patients with cirrhosis and HE were analyzed.

Of these patients, 60 (37.3%) developed SIRS and 40 (24.8%) died during hospitalization. Risk factors for death during hospitalization on univariate Cox analysis were as follows: a model for end-stage liver disease (MELD) score > 18; SIRS; serum C-reactive protein (CRP) > 10 mg/L; white blood cells (WBC), neutrophils (NEU), neutrophils/lymphocyte ratios (NLR), serum total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST); creatinine (Cr); international normalized ratio (INR). SIRS and a MELD score > 18, were significant independent risk factors (hazard ratio 4.758, 2.539; 95% confidence interval 2.115-10.703, 1.210-5.331; P < 0.001, P < 0.05, respectively). The 28-day survival rates were 95.8%, 89.6%, 61.1%, 37.5%, and 12.5% for SIRS scores of 0, 1, 2, 3, and 4, respectively (P < 0.001). Among patients with a MELD score ≤ 18, mortality was 7% in those without SIRS and 30% in those with SIRS. When a MELD score > 18, mortality was 16% in patients without SIRS and 62% in those with SIRS (P < 0.001). Among uninfected patients, mortality was 4% in those without SIRS and 43% in those with SIRS. Among infected patients the mortality rate was 19% in those who did not meet SIRS diagnostic criteria and 53% among those who met them (P < 0.001).

This study found that SIRS is a common independent risk factor for death among patients with liver cirrhosis hospitalized for HE. Early identification and treatment of SIRS is essential for improving survival in this patient population.