Clinical significance of systemic inflammatory response syndrome in the in-hospital outcome of hepatitis B cirrhotic patients with ascites

Abstract

Abstract: Objective To investigate the incidence of SIRS in HBV-related cirrhotic patients with ascites and determine its relationship with in-hospital outcome. Methods A study was conducted to explore the incidence of SIRS in HBV-related cirrhotic patients with ascites admitted to the Second Hospital of Nanjing from January 2013 to January 2018 and its relationship with clinical index, death and portal hypertension-related complications (including esophagogastric varices bleeding, hepatic encephalopathy and hepatorenal syndrome) during hospitalization, to further analyze the predictors of death and portal hypertension-related complications in these patients. Results There were 461 HBV-related cirrhotic patients with ascites, of which 185 had SIRS, with an incidence rate of 40.1%. We found significant correlation between SIRS and high incidence of jaundice, bacterial infection on admission, serum bilirubin, INR, Child-Pugh score, MELD score, the duration of hospital stay and low hemoglobin concentration, platelet concentration, and sodium concentration (all P<0.05). During in-hospital follow-up, 22 patients died (5.8%), 8 developed portal hypertension-related bleeding (1.7%), 4 developed hepatorenal syndrome type-1 (0.9%), and 20 developed encephalopathy (4.3%). SIRS was demonstrated to be related both to death (P<0.001) and portal hypertension-related complications(P<0.001). MELD score was the predictor of death and portal hypertension-related complications (P<0.001), while SIRS and hemoglobin were the predictors of portal hypertension related-complications (P<0.05). Conclusion SIRS is common in HBV-related cirrhotic patients with ascites, further aggravating liver function, which leads to higher incidence of in-hospital mortality and portal hypertension-related complications. The presence of SIRS can predict portal hypertension-related complications.

Key words: Systemic inflammatory response syndrome, hepatitis B cirrhotic patients with ascites, Death, Portal hypertension-related complications

Ji Tingting, Ye Wei, Zhao Wei. Clinical significance of systemic inflammatory response syndrome in the in-hospital outcome of hepatitis B cirrhotic patients with ascites[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(1): 20-24.

References

[1] Wang FS, Fan JG, Zhang Z, et al.The global burden of liver disease: the major impact of China[J]. Hepatology, 2014, 60(6): 2099-2108.
[2] D'amico G, Morabito A, Pagliaro L, et al. Survival and prognostic indicators in compensated and decompensated cirrhosis[J]. Dig Dis Sci, 1986, 31(5): 468-475.
[3] Bone RC, Balk RA, Cerra FB, et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[J]. Chest, 1992, 101(6): 1644-1655.
[4] Arvaniti V, D'Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis[J]. Gastroenterology, 2010, 139(4): 1246-1256.
[5] Singer M, Deutschman CS, Seymour CW, et al.The third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 801-810.
[6] Cazzaniga M, Dionigi E, Gobbo G, et al.The systemic inflammatory response syndrome in cirrhotic patients: relationship with their in-hospital outcome[J]. J Hepatol, 2009, 51(3): 475-482.
[7] Cirera I, Bauer TM, Navasa M, et al.Bacterial translocation of enteric organisms in patients with cirrhosis[J]. J Hepatol, 2001, 34(1): 32-37.
[8] Kalambokis G, Tsianos EV.Endotoxaemia in the pathogenesis of cytopenias in liver cirrhosis. Could oral antibiotics raise blood counts?[J]. Med Hypotheses, 2011, 76(1): 105-109.
[9] De Franchis R.Expanding consensus in portal hypertension: report of the baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752.
[10] 张俊勇, 蒯景华, 贾继东, 等. 肝硬化门静脉高压并发症对预后的影响[J]. 中华肝脏病杂志, 2009, 17(4): 263-265.
[11] Salerno F, Gerbes A, Ginès P, et al.Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis[J]. Gut, 2007, 56(9): 1310-1318.
[12] Kamath PS, Kim WR.The model for end‐stage liver disease (MELD)[J]. Hepatology, 2007, 45(3): 797-805.
[13] Thabut D, Massard J, Gangloff A, et al.Model for end‐stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure[J]. Hepatology, 2007, 46(6): 1872-1882.