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Systemic inflammatory response syndrome in acute‐on‐chronic liver failure: Relevance of ‘golden window’: A prospective study
Author(s) -
Choudhury Ashok,
Kumar Manoj,
Sharma Barjesh C,
Maiwall Rakhi,
Pamecha Viniyendra,
Moreau Richard,
Chawla Yogesh K,
Duseja Ajay,
Mahtab Mamun,
Rahman Salimur,
Hamid Saeed S,
Butt Amna S,
Jafri Wasim,
Tan Seok Siam,
Devarbhavi Harshad,
Amarapurkar Deepak,
Ning Qin,
Eapen C E,
Goel Ashish,
Kim Dong J,
Ghazinyan Hasmik,
Shiha Gamal,
Lee Guan H,
Abbas Zaigham,
Payawal Diana A,
Dokmeci A Kadir,
Yuen ManFung,
Lesmana Laurentius A,
Sood Ajit,
Chan Albert,
Lau George K,
Jia Ji Dong,
Duan Zhongping,
Yu Chen,
Yokosuka Osamu,
Jain Priyanka,
Bhadoria Ajeet S,
Kumar Guresh,
Sarin Shiv K
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13799
Subject(s) - medicine , systemic inflammatory response syndrome , sepsis , odds ratio , gastroenterology , incidence (geometry) , confidence interval , prospective cohort study , cumulative incidence , liver transplantation , transplantation , physics , optics
Background and Aim Systemic inflammatory response syndrome (SIRS) is an early marker of sepsis and ongoing inflammation and has been reported in large proportion of acute‐on‐chronic liver failure (ACLF) patients. Whether sepsis is the cause or the result of liver failure is unclear and is vital to know. To address this, the study investigated the course and outcome of ACLF patients without SIRS/sepsis. Methods Consecutive ACLF patients were monitored for the development of SIRS/sepsis and associated complications and followed till 90 days, liver transplant or death. Results Of 561 patients, 201 (35.8%) had no SIRS and 360 (64.2%) had SIRS with or without infection. New onset SIRS and sepsis developed in 74.6% and 8% respectively in a median of 7 (range 4–15) days, at a rate of 11% per day. The cumulative incidence of new SIRS was 29%, 92.8%, and 100% by days 4, 7, and 15. Liver failure, that is, bilirubin > 12 mg/dL (odds ratio [OR] = 2.5 [95% confidence interval {CI} = 1.05–6.19], P = 0.04) at days 0 and 4, and renal failure at day 4 (OR = 6.74 [95%CI = 1.50–13.29], P = 0.01), independently predicted new onset SIRS. Absence of SIRS in the first week was associated with reduced incidence of organ failure (20% vs 39.4%, P = 0.003), as was the 28‐day (17.6% vs 36%, P = 0.02) and 90‐day (27.5% vs 51%, P = 0.002) mortality. The 90‐day mortality was 61.6% in the total cohort and that for those having no SIRS and SIRS at presentation were 42.8% and 65%, respectively ( P < 0.001). Conclusion Liver failure predicts the development of SIRS. New onset SIRS in the first week is an important determinant of early sepsis, organ failure, and survival. Prompt interventions in this ‘golden window’ before development of sepsis may improve the outcome of ACLF.