Yang Danhong, Xie Yuanjun, Pan Hongying, Huang Yicheng, Dai Yining, Tong Yongxi, Chen Meijuan
Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China.
The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Hepatol Res. 2017 Oct;47(11):1174-1185. doi: 10.1111/hepr.12886. Epub 2017 May 19.
Our objective is to study the clinical characteristics of cirrhosis patients with SIRS and investigate its prognostic factors.
We analyzed 285 consecutive patients and their data were evaluated retrospectively. Data were compared in patients with/without SIRS during hospitalization. Univariate and multivariate Cox regression analyses were undertaken separately for cirrhotic patients with SIRS to assess predictive factors for 90-day mortality.
The mortality was 38.24% (52/136) in patients with SIRS and 6.04% (9/149) in patients without SIRS for 90-day follow-up (P < 0.001). The univariate analysis showed gastrointestinal hemorrhage (P < 0.001), hepatic encephalopathy (P < 0.001), albumin <30 g/L (P < 0.037), creatinine (Cr) >175 µmol/L (P < 0.001), cholinesterase(ChE) activity <3000 U/L (P = 0.019), white blood cell count ≥10 000 (109/L) (P = 0.018), neutrophils ≥80% (P = 0.018), C-reactive protein (CRP) ≥25 mg/L (P < 0.001), procalcitonin ≥1.0 ng/mL (P = 0.007), Child-Pugh class C (P < 0.001), septicemia (P < 0.001), pulmonary infection (P < 0.001),multi-site infection (P = 0.001), acute-on-chronic liver failure (ACLF) (P < 0.001), and advanced hepatocellular carcinoma (HCC) (P < 0.001). In multivariate analysis, only Cr ≥175 µmol/L (hazard ratio [HR] = 2.768; confidence interval [CI], 1.53-5.04; P = 0.001), C-reactive protein ≥25 mg/L (HR = 3.179; CI, 1.772-7.03; P = 0.004), multi-site infection (HR = 19.427; CI, 7.484-50.431; P < 0.001), ACLF (HR = 7.308; CI, 3.048-17.521; P < 0.001), advanced HCC (HR = 2.523; CI, 1.019-6.248; P = 0.045) were independent predictors of 90-day mortality in cirrhotic patients with SIRS.
Cr ≥ 175 µmol/L, CRP ≥ 25 mg/L, multi-site infection, ACLF, and advanced HCC independently predicted a higher rate of 90-day mortality in liver cirrhosis with SIRS.
我们的目标是研究伴有全身炎症反应综合征（SIRS）的肝硬化患者的临床特征，并探讨其预后因素。
我们分析了285例连续患者，对他们的数据进行回顾性评估。比较了住院期间伴有/不伴有SIRS患者的数据。对伴有SIRS的肝硬化患者分别进行单因素和多因素Cox回归分析，以评估90天死亡率的预测因素。
90天随访时，伴有SIRS的患者死亡率为38.24%（52/136），不伴有SIRS的患者死亡率为6.04%（9/149）（P＜0.001）。单因素分析显示，胃肠道出血（P＜0.001）、肝性脑病（P＜0.001）、白蛋白＜30g/L（P＜0.037）、肌酐（Cr）＞175μmol/L（P＜0.001）、胆碱酯酶（ChE）活性＜3000U/L（P = 0.019）、白细胞计数≥10000（10⁹/L）（P = 0.018）、中性粒细胞≥80%（P = 0.018）、C反应蛋白（CRP）≥25mg/L（P＜0.001）、降钙素原≥1.0ng/mL（P = 0.007）、Child-Pugh C级（P＜0.001）、败血症（P＜0.001）、肺部感染（P＜0.001）、多部位感染（P = 0.001）、慢加急性肝衰竭（ACLF）（P＜0.001）和晚期肝细胞癌（HCC）（P＜0.001）。多因素分析显示，只有Cr≥175μmol/L（风险比[HR]=2.768；置信区间[CI]，1.53 - 5.04；P = 0.001）、C反应蛋白≥25mg/L（HR = 3.179；CI，1.772 - 7.03；P = 0.004）、多部位感染（HR = 19.427；CI，7.484 - 50.431；P＜0.001）、ACLF（HR = 7.308；CI，3.048 - 17.521；P＜0.001）、晚期HCC（HR = 2.523；CI，1.019 - 6.248；P = 0.045）是伴有SIRS的肝硬化患者90天死亡率的独立预测因素。
Cr≥175μmol/L、CRP≥25mg/L、多部位感染、ACLF和晚期HCC独立预测伴有SIRS的肝硬化患者90天死亡率较高。
