The systemic inflammatory response syndrome in cirrhotic patients: relationship with their in-hospital outcome.
OBJECTIVE
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.
Cazzaniga
Massimo
M
Department of Internal Medicine, IRCCS Policlinico San Donato, University of Milan, 20097 San Donato Milanese, Milan, Italy. massimo.cazzaniga@unimi.it
Dionigi
Elena
E
Gobbo
Giulia
G
Fioretti
Alessia
A
Monti
Valentina
V
Salerno
Francesco
F
D000368:Aged; D001663:Bilirubin / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D017093:Liver Failure / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000503:physiopathology; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000503:physiopathology; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*
D003404:Creatinine; D001663:Bilirubin