The systemic inflammatory response syndrome (SIRS) in cirrhotic patients: Relationship with the in-hospital outcome

Department of Internal Medicine, IRCCS Policlinico San Donato, University of Milan, 20097 San Donato Milanese, Milan, Italy.
Journal of Hepatology (Impact Factor: 11.34). 05/2009; 51(3):475-82. DOI: 10.1016/j.jhep.2009.04.017
Source: PubMed

ABSTRACT 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.
Presence of SIRS was assessed on admission and during hospital stay. Main clinical outcomes were death and development of portal hypertension-related complications.
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.
SIRS frequently occurs in patients with advanced cirrhosis and is associated with a poor outcome.

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Available from: Massimo Cazzaniga, Sep 26, 2015
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    • "Although some studies on SBP have evaluated prognostic factors such as renal insufficiency, type of organism, bacteremia, and MELD score [23]–[31], no standard marker has been determined to predict SBP mortality. CRP [32] and SIRS [33] are common diagnostic parameters suggested for use as prognostic markers for SBP, but their values diminish when considering cirrhotic patients [6]. Although DNI has been suggested to predict mortality in other infectious conditions [12]–[15], [34], no reports have estimated the prognostic value of DNI in cirrhotic patients with SBP. "
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    ABSTRACT: Spontaneous bacterial peritonitis (SBP) is a common and life-threatening infection in patients with advanced cirrhosis. The prognostic value of a novel marker, the delta neutrophil index (DNI), was investigated relative to mortality in patients with SBP. Seventy-five patients with SBP were studied from April 2010 to May 2012. DNI at initial diagnosis of SBP was determined and compared with 30-day mortality rates. Of the patients, 87.7% were men, and the median age of all patients was 59.0 yrs. The area under the receiver-operating characteristic (ROC) curve of DNI for 30-day mortality was 0.701 (95% confidence interval [CI], 0.553-0.849; p = 0.009), which was higher than that of C-reactive protein (0.640, 95% CI, 0.494-0.786; p = 0.076) or the model for end-stage liver disease score (0.592, 95% CI, 0.436-0.748; p = 0.235). From the ROC curve, with the sum of sensitivity and specificity, the cutoff value of DNI was determined to be 5.7%. In the high-DNI group (DNI ≥5.7%), septic shock and 30-day mortality were more prevalent compared with the low-DNI group (84.2% vs. 48.2%, p = 0.007; 57.9% vs. 14.3%, p<0.001, respectively). Patients with an elevated DNI had a higher risk of 30-day mortality compared with those with a low DNI (4.225, 95% CI, 1.631-10.949; p = 0.003). A higher DNI at the time of SBP diagnosis is an independent predictor of 30-day mortality in patients with SBP.
    PLoS ONE 01/2014; 9(1):e86884. DOI:10.1371/journal.pone.0086884 · 3.23 Impact Factor
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    • "The additional main finding of this study is that a high SIRS score was predictive of HE in dogs with a cPSS. This finding is consistent with studies in humans with liver disease and HE [36-39]. The mechanism by which a SIRS may influence the development of HE is unclear although the presence of a SIRS has been shown to exacerbate the neuropsychological effects of induced hyperammonemia in humans [14]. "
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    PLoS ONE 01/2014; 9(1):e82303. DOI:10.1371/journal.pone.0082303 · 3.23 Impact Factor
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