title: Risk factors for mortality in cirrhotic patients with sepsis.
abstract: BACKGROUND
  Patients with cirrhosis and sepsis had increased mortality.
  
  
  OBJECTIVE
  Determine factors associated with increased in-hospital mortality in cirrhotic patients admitted for sepsis.
  
  
  METHODS
  All cirrhotic patients admitted from 2004 to 2007 for sepsis were identified from hospital electronic database. Patients were included if they had liver cirrhosis and sepsis, defined as identified sources of infection, and at least one of fever, altered total white cell count, or raised C-reactive protein. Baseline characteristics, investigations, infections, and outcomes were collected. Main outcome measure was in-hospital mortality.
  
  
  RESULTS
  A total of 205 admissions in 153 patients were included. In-hospital mortality rate was 24.4%. In predicting in-hospital death, area under the receiver-operating-characteristic curve for Child-Pugh score was 0.934, with optimum cut-off at 10 and above, while for model for end-stage liver disease (MELD) score was 0.751, with optimum cut-off at 17 and above. Four factors were significantly associated with in-hospital mortality on multivariate analysis: presence of >1 site of infection, pneumonia, Child's C status, and MELD score 17 and above. In-hospital mortality rate increased with more factors: 0% with no factor, 7% with one factor, 21% with two factors, 87% with three factors, and 100% with four factors. The mortality of those with <3 risk factors was significantly lower than those with three or more risk factors (7 vs. 91%, p = 0.000).
  
  
  CONCLUSIONS
  Septic cirrhotic patients with pneumonia, >1 site of infection, Child's C cirrhosis, and high MELD score had a high mortality risk.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.
authors.forename: Lee-Guan
authors.initials: LG
authors.lastname: Lim
authors.forename: Xiang-Xuan Eunice
authors.initials: XX
authors.lastname: Tan
authors.forename: Shu-Jeng
authors.initials: SJ
authors.lastname: Woo
authors.forename: Yock-Young
authors.initials: YY
authors.lastname: Dan
authors.forename: Yin-Mei
authors.initials: YM
authors.lastname: Lee
authors.forename: Vincent
authors.initials: V
authors.lastname: Lai
authors.forename: Seng-Gee
authors.initials: SG
authors.lastname: Lim