Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.
Hepatol Int. 2011 Sep;5(3):800-7. doi: 10.1007/s12072-011-9258-y. Epub 2011 Feb 13.
Patients with cirrhosis and sepsis had increased mortality.
Determine factors associated with increased in-hospital mortality in cirrhotic patients admitted for sepsis.
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.
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).
Septic cirrhotic patients with pneumonia, >1 site of infection, Child's C cirrhosis, and high MELD score had a high mortality risk.
肝硬化合并脓毒症患者的死亡率增加。
确定与肝硬化患者因脓毒症住院死亡率增加相关的因素。
从医院电子数据库中确定 2004 年至 2007 年因脓毒症住院的所有肝硬化患者。如果患者有肝硬化和脓毒症，定义为确定感染源，且至少有发热、总白细胞计数改变或 C 反应蛋白升高，则将患者纳入研究。收集基线特征、检查、感染和结果。主要观察指标为住院死亡率。
共纳入 153 例患者 205 例次住院。住院死亡率为 24.4%。在预测住院死亡方面，Child-Pugh 评分的受试者工作特征曲线下面积为 0.934，最佳截断值为 10 分以上，而终末期肝病模型（MELD）评分的曲线下面积为 0.751，最佳截断值为 17 分以上。多因素分析显示，存在>1 个感染部位、肺炎、Child C 状态和 MELD 评分 17 分以上是与住院死亡率相关的四个显著因素。住院死亡率随因素数量的增加而增加：无因素时为 0%，有 1 个因素时为 7%，有 2 个因素时为 21%，有 3 个因素时为 87%，有 4 个因素时为 100%。具有<3 个危险因素的患者死亡率显著低于具有 3 个或更多危险因素的患者（7%比 91%，p=0.000）。
患有肺炎、>1 个感染部位、Child C 肝硬化和高 MELD 评分的脓毒症肝硬化患者死亡率高。
