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


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
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    • "The presence of SIRS can compromise the function of various organ systems resulting in Multiple Organ Dysfunction Syndrome (MODS)[11]. Hospitalised human patients with cirrhosis and SIRS have more severe hepatic encephalopathy (HE), are more likely to develop hepatorenal syndrome and have non-reversible renal dysfunc- tion[12]. In acute liver failure, the presence of SIRS, whether or not precipitated by infection, has been implicated in the progression of HE, reducing the chances of transplantation and conferring a poorer prognosis[13]. "
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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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