The systemic inflammatory response syndrome in cirrhotic patients: relationship with their 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: 9.86). 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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