Behroozian Ramin, Bayazidchi Mehrdad, Rasooli Javad
Department of Gastroenterology, Emam Hospital, Orumieh University of Medical Sciences, Orumieh, Iran.
Middle East J Dig Dis. 2012 Jul;4(3):168-72.
The evidence saying that the rate of Systemic Inflammatory Response Syndrome (SIRS) is high in patients with advanced cirrhosis and portal hypertension, this could have negative outcome on patients prognosis.
This prospective study included 109 cirrhotic patients who were admitted to Imam Khomeini Hospital, affiliated with Orumieh University of Medical Sciences, during 2011-2012. The presence of SIRS and the model for end stage liver disease (MELD) were assessed on admission and during the hospital stay. SIRS was considered positive if patients had two or more of the following: temperature of >38ºC or <36ºC; heart rate >90 beats/min; respiratory rate >20/min or PaCO2 <32 mmHg or the use of mechanical ventilation; WBC >12000/mm(3) or <4000/mm(3) or more than 10% immature neutrophil count. MELD was calculated as: MELD = 3.8 [Ln serum bilirubin (mg/dl)] +11.2 [Ln INR] +9.6 [Ln serum creatinine (mg/dl)] +6.4. Hospital outcome was defined as death or hospital discharge.
A total of 109 cirrhotic patients between the ages of 14 to 84 (mean: 54.6 ±18.4) years were included. There were 65 (59%) male patients. Of the 109 patients, 76 (69.8%) were SIRS-negative and 33 (30.2%) were SIRS-positive. The mean calculated MELD score for all patients was 15.5. There was a correlation noted between SIRS and high serum creatinine levels (p=0.01) and between SIRS and a high MELD score (p=0.00). During follow-up 19 (17.4%) patients died. SIRS was correlated with death (p<0.00) on multivariate analysis, SIRS was independently associated with hospital death.
SIRS is a relatively frequent event in cirrhotic patients admitted to referral centers. It is closely related to the severity of liver disease as shown by the MELD score. SIRS independently and adversely affects the in-hospital outcome in patients with liver cirrhosis.
有证据表明，晚期肝硬化和门静脉高压患者的全身炎症反应综合征（SIRS）发生率较高，这可能对患者预后产生负面影响。
这项前瞻性研究纳入了2011年至2012年期间入住与乌尔米耶医科大学附属的伊玛目霍梅尼医院的109例肝硬化患者。入院时及住院期间评估SIRS的存在情况以及终末期肝病模型（MELD）。如果患者出现以下两项或更多情况，则SIRS被视为阳性：体温>38℃或<36℃；心率>90次/分钟；呼吸频率>20次/分钟或动脉血二氧化碳分压<32mmHg或使用机械通气；白细胞计数>12000/mm³或<4000/mm³或未成熟中性粒细胞计数超过10%。MELD的计算方法为：MELD = 3.8[血清胆红素（mg/dl）的自然对数] + 11.2[国际标准化比值（INR）的自然对数] + 9.6[血清肌酐（mg/dl）的自然对数] + 6.4。医院结局定义为死亡或出院。
共纳入109例年龄在14至84岁（平均：54.6±18.4）的肝硬化患者。其中男性患者65例（59%）。109例患者中，76例（69.8%）SIRS阴性，33例（30.2%）SIRS阳性。所有患者的平均计算MELD评分为15.5。SIRS与高血清肌酐水平之间存在相关性（p = 0.01），SIRS与高MELD评分之间也存在相关性（p = 0.）。随访期间，19例（17.4%）患者死亡。多因素分析显示SIRS与死亡相关（p<0.00），SIRS独立与医院死亡相关。
SIRS在转诊中心收治的肝硬化患者中是相对常见的事件。如MELD评分所示，它与肝病严重程度密切相关。SIRS独立且对肝硬化患者的院内结局产生不利影响。
