Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Department of Gastroenterology and Hepatology, Bonsucesso Federal Hospital, Rio de Janeiro, Brazil.
Can J Gastroenterol Hepatol. 2021 Apr 25;2021:5581587. doi: 10.1155/2021/5581587. eCollection 2021.
Although recently challenged, systemic inflammatory response syndrome (SIRS) criteria are still commonly used in daily practice to define sepsis. However, several factors in liver cirrhosis may negatively impact its prognostic ability. . To investigate the factors associated with the presence of SIRS, the characteristics of SIRS related to infection, and its prognostic value among patients hospitalized for acute decompensation of cirrhosis. . In this cohort study from two tertiary hospitals, 543 patients were followed up, up to 90 days. Data collection, including the prognostic models, was within 48 hours of admission.
SIRS was present in 42.7% of the sample and was independently associated with upper gastrointestinal bleeding (UGB), ACLF, infection, and negatively related to beta-blockers. SIRS was associated with mortality in univariate analysis, but not in multiple Cox regression analysis. The Kaplan-Meier survival probability of patients without SIRS was 73.0% and for those with SIRS was 64.7%. The presence of SIRS was not significantly associated with mortality when considering patients with or without infection, separately. Infection in SIRS patients was independently associated with Child-Pugh C and inversely related to UGB. Among subjects with SIRS, mortality was independently related to the presence of infection, ACLF, and Child-Pugh C.
SIRS was common in hospitalized patients with cirrhosis and was of no prognostic value, even in the presence of infection.
尽管最近受到了挑战，全身炎症反应综合征（SIRS）标准仍在日常实践中广泛用于定义脓毒症。然而，肝硬化的几个因素可能会对其预后能力产生负面影响。。本研究旨在调查与 SIRS 存在相关的因素、与感染相关的 SIRS 特征，以及在因肝硬化急性失代偿而住院的患者中的预后价值。。在这两项来自两所三级医院的队列研究中，对 543 例患者进行了随访，最长随访时间为 90 天。数据收集，包括预后模型，均在入院后 48 小时内完成。
样本中存在 SIRS 的比例为 42.7%，其与上消化道出血（UGB）、ACLF、感染独立相关，且与β受体阻滞剂呈负相关。SIRS 在单变量分析中与死亡率相关，但在多变量 Cox 回归分析中不相关。无 SIRS 的患者的 Kaplan-Meier 生存概率为 73.0%，而有 SIRS 的患者为 64.7%。在分别考虑有或无感染的患者时，SIRS 的存在与死亡率无显著相关性。SIRS 患者的感染与 Child-Pugh C 独立相关，与 UGB 呈负相关。在存在 SIRS 的患者中，死亡率与感染、ACLF 和 Child-Pugh C 的存在独立相关。
在住院的肝硬化患者中，SIRS 很常见，但其预后价值有限，即使在存在感染的情况下也是如此。
