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 23 February 2018

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News

‘Golden window’ for systemic inflammatory response syndrome in acute-on-chronic liver failure

The most recent issue of the Journal of Gastroenterology & Hepatology examines the course, and outcome of acute-on-chronic liver failure patients without systemic inflammatory response syndrome/sepsis.

News image

Systemic inflammatory response syndrome is an early marker of sepsis and ongoing inflammation and has been reported in large proportion of acute-on-chronic liver failure patients.

Whether sepsis is the cause or the result of liver failure is unclear and is vital to know.

Dr Ashok Choudhury and colleagues investigated the course, and outcome of acute-on-chronic liver failure patients without systemic inflammatory response syndrome/sepsis.

Consecutive acute-on-chronic liver failure patients were monitored for the development of systemic inflammatory response syndrome/sepsis and associated complications and followed till 90 days, liver transplant or death.

Of 561 patients, the team noted that 36% had no systemic inflammatory response syndrome and 64% had systemic inflammatory response syndrome with or without infection.

New onset systemic inflammatory response syndrome developed in 75%
Journal of Gastroenterology & Hepatology

New onset systemic inflammatory response syndrome and sepsis developed in 75% and 8% respectively in a median of 7 days, at a rate of 11% per day.

The researchers noted that cumulative incidence of new systemic inflammatory response syndrome was 29%, 93%, and 100% by days 4, 7, and 15.

Liver failure, that is, bilirubin > 12 mg/dL at days 0 and 4, and renal failure at day 4, independently predicted new onset systemic inflammatory response syndrome.

The team found that absence of systemic inflammatory response syndrome in the first week was associated with reduced incidence of organ failure, as was the 28-day, and 90-day mortality.

The 90-day mortality was 62% in the total cohort and that for those having no systemic inflammatory response syndrome and systemic inflammatory response syndrome at presentation were 43% and 65%, respectively.

Dr Choudhury's team concludes, "Liver failure predicts the development of systemic inflammatory response syndrome."

"New onset systemic inflammatory response syndrome 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 acute-on-chronic liver failure."

J Gastroenterol Hepatol 2017: 32(12): 1989–1997
06 December 2017

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