title: SIRS score reflects clinical features of non-acetaminophen-related acute liver failure with hepatic coma.
abstract: OBJECTIVE
  In acetaminophen-induced acute liver failure (ALF), the hepatic coma grade worsens and mortality rates increase, as the number of systemic inflammatory response syndrome components fulfilled (SIRS score) increases. This study aimed to investigate the impact of SIRS score on clinical features of non-acetaminophen-related ALF.
  
  
  METHODS
  Ninety-nine patients with non-acetaminophen-related ALF with hepatic coma who did not undergo liver transplantation were investigated. Each patient was given a SIRS score of 0, 1, 2, 3 or 4 at the time of diagnosis.
  
  
  RESULTS
  At the diagnosis of ALF with hepatic coma, with the increase of SIRS score, hepatic coma grade and prothrombin activity were deteriorated. After the diagnosis of ALF with hepatic coma, 25 patients (25%) developed acute respiratory distress syndrome (ARDS), 31 patients (31%) developed disseminated intravascular coagulation (DIC), and 21 patients (22%) developed acute renal failure (ARF). Thirty-eight patients (38%) developed MOF. With the increase of SIRS score, frequencies of the development of ARDS, DIC and MOF increased. ARF was more frequently developed in patients with a SIRS score of 2 or higher. Overall, 36 patients (36%) survived. Overall survival rate was 66% in 29 patients with a score of 0, 43% in 21 patients with a score of 1, 17% in 29 patients with a score of 2 and 15% in 20 patients with a score of 3 or 4.
  
  
  CONCLUSIONS
  SIRS score will be useful for predicting not only the overall survival but also the development of complications such as ARDS, DIC and MOF in non-acetaminophen-related ALF with hepatic coma.
authors.affiliation: Department of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan. miyakeyasuhiro@hotmail.com
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yasunaka
authors.forename: Fusao
authors.initials: F
authors.lastname: Ikeda
authors.forename: Akinobu
authors.initials: A
authors.lastname: Takaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nouso
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000082:Acetaminophen; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000401:mortality; D055815:Young Adult
chemical_list: D000082:Acetaminophen