Correlation between systemic inflammatory response syndrome and prognosis of patients with cirrhosis and hepatic encephalopathy.

BACKGROUND: Although systemic inflammatory response syndrome (SIRS) is associated with the progression of cirrhosis, its clinical significance in patients with cirrhosis and hepatic encephalopathy (HE) remains unclear.

METHODS: Here, clinical data of 161 hospitalized patients with cirrhosis and HE were analyzed.

RESULTS: Of these patients, 60 (37.3%) developed SIRS and 40 (24.8%) died during hospitalization. Risk factors for death during hospitalization on univariate Cox analysis were as follows: a model for end-stage liver disease (MELD) score > 18; SIRS; serum C-reactive protein (CRP) > 10 mg/L; white blood cells (WBC), neutrophils (NEU), neutrophils/lymphocyte ratios (NLR), serum total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST); creatinine (Cr); international normalized ratio (INR). SIRS and a MELD score > 18, were significant independent risk factors (hazard ratio 4.758, 2.539; 95% confidence interval 2.115-10.703, 1.210-5.331; P < 0.001, P < 0.05, respectively). The 28-day survival rates were 95.8%, 89.6%, 61.1%, 37.5%, and 12.5% for SIRS scores of 0, 1, 2, 3, and 4, respectively (P < 0.001). Among patients with a MELD score ≤ 18, mortality was 7% in those without SIRS and 30% in those with SIRS. When a MELD score > 18, mortality was 16% in patients without SIRS and 62% in those with SIRS (P < 0.001). Among uninfected patients, mortality was 4% in those without SIRS and 43% in those with SIRS. Among infected patients the mortality rate was 19% in those who did not meet SIRS diagnostic criteria and 53% among those who met them (P < 0.001).

CONCLUSIONS: This study found that SIRS is a common independent risk factor for death among patients with liver cirrhosis hospitalized for HE. Early identification and treatment of SIRS is essential for improving survival in this patient population.