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

doi:10.1016/j.jhep.2009.04.017

Journal of Hepatology

Volume 51, Issue 3, September 2009, Pages 475-482

https://doi.org/10.1016/j.jhep.2009.04.017 Get rights and content

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.

Introduction

There is growing evidence that systemic inflammation is quite frequent in patients with advanced cirrhosis and portal hypertension, and might be associated with a negative outcome [1]. Systemic inflammation can be caused by overt or occult bacterial infection and can affect clotting function [2], [3]. In cirrhotic patients inflammation has been shown to favor serious complications such as variceal bleeding, encephalopathy and acute-on-chronic liver failure [4]. Accordingly, Thabut et al. [1] showed that inflammation increases the risk of complications and death in cirrhotic patients with acute renal damage.

Excluding hepatocellular carcinoma (HCC), the in-hospital outcome of patients with advanced cirrhosis is mainly driven by liver and/or renal dysfunction [5], [6]. In this setting the role of systemic inflammation has been poorly investigated, even if inflammation can affect both renal and hepatic function.

The aim of this prospective study was to determine (i) the prevalence of systemic inflammation in a cohort of cirrhotic patients consecutively admitted to a tertiary referral centre, (ii) its relationship with liver and kidney function, and (iii) its relationship with the in-hospital outcome. The main endpoints were death and development of portal hypertension-related complications.

Section snippets

Patients

Cirrhotic patients consecutively admitted to our ward from February to September 2004 were enrolled in this study. Inclusion criteria were diagnosis of cirrhosis based on liver biopsy or on obvious clinical, biochemical and imaging features. Exclusion criteria were age <18 years; ongoing cardiac failure (NYHA classes II–IV); organic kidney disease; treatment for chronic obstructive pulmonary disease; diagnosis of HCC or of extrahepatic malignancy; human immunodeficiency virus-positivity; use of

Patients

One hundred and fifty-nine cirrhotic patients were consecutively admitted to hospital. Eighteen patients were excluded according to the study criteria (12 patients with HCC; 2 patients with organic kidney disease; 1 patient with cardiac failure; 1 patient with severe chronic obstructive pulmonary disease; 2 patients with extrahepatic malignancy). The remaining 141 patients were enrolled. They were 100 males and 41 females, with a mean age of 60 ± 14 years. Most patients had severe liver disease

Discussion

This study shows that: (i) SIRS is a relatively frequent event in patients admitted to a tertiary referral centre because of complications due to cirrhosis; (ii) SIRS in cirrhotic patients is closely related to severity of liver disease as shown by the relationship with serum bilirubin, INR, jaundice and MELD score; (iii) SIRS predicts the development of portal hypertension-related complications; (iv) SIRS adversely affect the in-hospital cirrhotic survival.

According to these findings and to

Acknowledgement

Elena Dionigi received a grant form COPEV (Associazione per la Prevenzione e Cura dell’Epatite Virale “Beatrice Vitiello”).

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^☆: The authors declared that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.

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

Background/Aims

Methods

Results

Conclusions

Introduction

Section snippets

Patients

Patients

Discussion

Acknowledgement

Chest

J Hepatol

Hepatology

J Hepatol

Hepatology

Dig Liver Dis

Lancet

J Hepatol

Hepatology

J Hepatol

J Hepatol

Lancet

Gastroenterology

J Hepatol

Hepatology

J Hepatol

Am J Gastroenterol

J Hepatol