Miyake Yasuhiro, Yasunaka Tetsuya, Ikeda Fusao, Takaki Akinobu, Nouso Kazuhiro, Yamamoto Kazuhide
Department of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
Intern Med. 2012;51(8):823-8. doi: 10.2169/internalmedicine.51.6686. Epub 2012 Apr 15.
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.
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.
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.
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.
在对乙酰氨基酚诱导的急性肝衰竭（ALF）中，随着满足的全身炎症反应综合征成分数量（SIRS评分）增加，肝昏迷分级恶化且死亡率上升。本研究旨在调查SIRS评分对非对乙酰氨基酚相关性ALF临床特征的影响。
对99例未接受肝移植的非对乙酰氨基酚相关性肝昏迷ALF患者进行研究。每位患者在诊断时给予SIRS评分为0、1、2、3或4分。
在诊断为肝昏迷的ALF时，随着SIRS评分增加，肝昏迷分级和凝血酶原活性恶化。在诊断为肝昏迷的ALF后，25例患者（25%）发生急性呼吸窘迫综合征（ARDS），31例患者（31%）发生弥散性血管内凝血（DIC），21例患者（22%）发生急性肾衰竭（ARF）。38例患者（38%）发生多器官功能衰竭（MOF）。随着SIRS评分增加，ARDS、DIC和MOF的发生频率增加。SIRS评分为2分及以上的患者更常发生ARF。总体而言，36例患者（36%）存活。SIRS评分为0分的29例患者总体生存率为66%，评分为1分的21例患者为43%，评分为2分的29例患者为17%，评分为3分或4分的20例患者为15%。
SIRS评分不仅有助于预测非对乙酰氨基酚相关性肝昏迷ALF的总体生存率，还能预测ARDS、DIC和MOF等并发症的发生。
