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Systemic inflammatory response syndrome in acute-on-chronic liver failure: Relevance of "golden window': A prospective study

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收录情况： ◇ SCIE

作者：
Ashok Choudhury[1] * ; Manoj Kumar[1] ; Barjesh C Sharma[1] ; Rakhi Maiwall[1] ; Viniyendra Pamecha[2] ; Richard Moreau [3,4] ; Yogesh K Chawla[5] ; Ajay Duseja[5] ; Mamun Mahtab[6] ; Salimur Rahman[6] ; Saeed S Hamid[7] ; Amna S Butt[7] ; Wasim Jafri[7] ; Seok Siam Tan[8] ; Harshad Devarbhavi[9] ; Deepak Amarapurkar[10] ; Qin Ning[11] ; C E Eapen[12] ; Ashish Goel[12] ; Dong J Kim[13] ; Hasmik Ghazinyan[14] ; Gamal Shiha[15] ; Guan H Lee[16] ; Zaigham Abbas[17] ; Diana A Payawal[18] ; A Kadir Dokmeci[19] ; Man-Fung Yuen[20] ; Laurentius A Lesmana[21] ; Ajit Sood[22] ; Albert Chan[23] ; George K Lau[24] ; Ji Dong Jia[25] ; Zhongping Duan[26] ; Chen Yu[27] ; Osamu Yokosuka[27] ; Priyanka Jain[1] ; Ajeet S Bhadoria[1] ; Guresh Kumar[1] ; Shiv K Sarin[1] ;
单位： [1]Department of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi, India [2]Department of Hepatobiliary Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India [3]The National (French) Institute of Health (INSERM), Paris, France [4]UMR_S 1149, Labex INFLAMEX, Université Paris Diderot Paris 7, Paris, France [5]Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India [6]Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh [7]Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan [8]Department of Gastroenterology and Hepatology, Selayang Hospital, Kepong, Malaysia [9]Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India [10]Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research Centre, Mumbai, India [11]Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [12]Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India [13]Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, Korea [14]Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia [15]Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt [16]Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore [17]Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan [18]Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines [19]Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey [20]Department of Medicine, The University of Hong Kong, Hong Kong [21]Division of Hepatology, University of Indonesia, Jakarta, Indonesia [22]Department of Gastroenterology, Dayanand Medical College, Ludhiana, India [23]Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong [24]The Institute of Translational Hepatology, Beijing, China [25]Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China [26]Beijing Youan Hospital, Capital Medical University, Beijing, China [27]Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
出处：
DOI： 10.1111/jgh.13799
ISSN：

关键词： ACLF golden window SIRS

摘要：
Background and AimSystemic 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. MethodsConsecutive ACLF patients were monitored for the development of SIRS/sepsis and associated complications and followed till 90days, liver transplant or death. ResultsOf 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 >12mg/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). ConclusionLiver 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.

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中科院(CAS)分区：
出版当年[2016]版：
大类 | 2 区 医学
小类 | 3 区 胃肠肝病学
最新[2025]版：
大类 | 3 区 医学
小类 | 3 区 胃肠肝病学
JCR分区：
出版当年[2015]版：
Q2 GASTROENTEROLOGY & HEPATOLOGY
最新[2023]版：
Q2 GASTROENTEROLOGY & HEPATOLOGY

影响因子： 最新[2023版] 最新五年平均[2021-2025] 出版当年[2015版] 出版当年五年平均[2011-2015] 出版前一年[2014版] 出版后一年[2016版]

第一作者：
第一作者单位： [1]Department of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
通讯作者：
通讯机构： [*1]Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi-110 070, India.
推荐引用方式(GB/T 7714)：
Ashok Choudhury,Manoj Kumar,Barjesh C Sharma,et al.Systemic inflammatory response syndrome in acute-on-chronic liver failure: Relevance of "golden window': A prospective study[J].JOURNAL of GASTROENTEROLOGY and HEPATOLOGY.2017,32(12):1989-1997.doi:10.1111/jgh.13799.
APA：
Ashok Choudhury,Manoj Kumar,Barjesh C Sharma,Rakhi Maiwall,Viniyendra Pamecha...&Shiv K Sarin.(2017).Systemic inflammatory response syndrome in acute-on-chronic liver failure: Relevance of "golden window': A prospective study.JOURNAL of GASTROENTEROLOGY and HEPATOLOGY,32,(12)
MLA：
Ashok Choudhury,et al."Systemic inflammatory response syndrome in acute-on-chronic liver failure: Relevance of "golden window': A prospective study".JOURNAL of GASTROENTEROLOGY and HEPATOLOGY 32..12(2017):1989-1997

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