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

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. (C) 2009 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.