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Predicting in-hospital mortality in cirrhosis with systemic inflammatory response syndrome

Low eosinophil count predicts in-hospital mortality in cirrhosis with systemic inflammatory response syndrome, reports June's issue of the European Journal of Gastroenterology & Hepatology.

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Absolute eosinophil count and procalcitonin level may have a prognostic value in critically ill patients.

However, their role in cirrhotic patients has never been studied.

Dr Hardik Kotecha and colleagues evaluated the role of absolute eosinophil count and procalcitonin, obtained at admission, in predicting in-hospital mortality in cirrhotic patients with systemic inflammatory response syndrome.

The research team estimated levels of absolute eosinophil count and procalcitonin were estimated at admission in 100 patients.

Their outcome was correlated with these baseline parameters.

The doctors examined that etiology of cirrhosis was alcohol, cryptogenic, viral, and others.

Their median model for end-stage liver disease and Child–Turcotte–Pugh scores were 24 and 11, respectively.

The researchers noted that infection was present in 59 patients, and the rest of the 41 patients had systemic inflammatory response syndrome without infection.

63 patients recovered from systemic inflammatory response syndrome
European Journal of Gastroenterology & Hepatology

There was a significant difference between the median levels of absolute eosinophil count, and procalcitonin between patients who had infection, and those who did not have infection.

The doctors found that 63 patients recovered from systemic inflammatory response syndrome, and were discharged, 33 patients died, and 4 patients received orthotopic liver transplantation during the same admission.

Baseline absolute eosinophil count and procalcitonin levels were significantly different between patients who recovered and died.

On multivariate analysis, baseline absolute eosinophil count values could independently predict in-hospital mortality, in addition to model for end-stage liver disease and serum sodium.

The area under receiver operating characteristic curve of absolute eosinophil count for predicting mortality was 0.785, and the best cutoff of absolute eosinophil count, obtained by Youden’s index, was 104 cells/cumm, indicating that patients with baseline absolute eosinophil count values less than 104 cells/cumm had higher in-hospital mortality.

Dr Hardik's team commented, "In critically ill cirrhotic patients with systemic inflammatory response syndrome, a baseline absolute eosinophil count value of less than 104 cells/cumm accurately predicts in-hospital mortality."

"The prediction of mortality by Absolute eosinophil count is independent of the model for end-stage liver disease score and serum sodium."

Euro J of Gastroenterol & Hepatol 2013: 25(6): 676-682
13 June 2013

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