THE SIRS SCORE RELEVANCE FOR ASSESSMENT OF SYSTEMIC INFLAMMATION COMPARED TO C-REACTIVE PROTEIN IN PATIENTS WITH LIVER CIRRHOSIS

Abstract

Introduction. Systemic inflammation is a key mechanism that determines the natural history and prognosis inpatients with liver disease. The presence of systemic inflammation is usually assessed through the presence of systemic inflammatory response syndrome (SIRS), but due to numerous morphological and hemodynamic abnormalities the application of SIRS criteria in patients with liver cirrhosis is difficult and not entirely relevant. The aim of the study was to determine the SIRS occurrence by applying different diagnostic criteria and to analyze the relevancy of the parameters included in the SCCM/ESICM/ACCP/ATS/SIS score by comparison to CRP cut-off value of 29 mg/L. Methods. In patients with liver cirrhosis we estimated the occurrence of systemic inflammation by application of three SIRS criteria: the criterion of the International sepsis definitions conference of 2001 (SCCM/ESICM/ ACCP/ATS/SIS), the modified SIRS score and the CRP cut-off value of 29 mg/L. The positive findings of the parameters included in the SIRS score were compared to the CRP cut-off value in order to analyze their relevance in the assessment of SIRS. Results. Seventy-six patients were enrolled in the study, 60 males and 16 females with a mean age of 57±11 (31-84). The presence of SIRS was registered in 31 patients (40.79%) according to the first SIRS criterion, in 5 (6.58%) patients according to the second SIRS criterion and in 15 (27.63 %) patients according to the third SIRS criterion and the average CRP in the group was 21.61 mg/L±30.98 (0.5-158.90). The percentage difference in SIRS occurrence between the first and third SIRS criterion was statistically significant for p<0.05 {Difference test: Difference 21.05%[(6.45-34.49) CI 95%]; Chi-square=7.926;df=1 p=0.0049} in favor of a significantly larger number of patients with SIRS according to the first SIRS criterion and the percentage difference in SIRS occurrence between the second and the third SIRS criterion was statistically significant for p<0.05 {Difference test: Difference 13.16%[(2.33-24.12) CI 95%]; Chi-square=5.721; df=1 p=0.0168} in favor of a significantly larger number of patients with SIRS according to the third SIRS criterion. The percentage difference between the occurrence of positive finding of the analyzed parameters included in the SIRS score and the occurrence of positive finding of the same parameter in patients who fulfilled the third SIRS criterion was statistically significant for p<0.05for decreased partial pressure of CO2below 32 mmHg {Difference test: Difference 44.73%[(29.49-57.03) CI 95%]; Chi-square=30.98;df=1 p=0.0001}, for elevated respiratory rate above 20/min {Difference test: Difference 35.53% [(22.41-47.35) CI 95%]; Chi-square=25.87; df=1 p=0.0001}, for decreased leukocyte count below 4.000/mm³{Difference test: Difference 18.42%[(8.39-29.03) CI 95%]; Chi-square=12.271; df=1 p=0.0005} and for elevated heart rate above 90/min {Difference test: Difference 11.85%[(-1.71-22.34) CI 95%]; Chi-square=5.336;df=1 p=0.0209}. The percentage difference between the occurrence of positive finding of the analyzed parameters included in the SIRS score and the occurrence of positive finding of the same parameter in patients who fulfilled the third SIRS criterion was not statistically significant for p>0.05 for body temperature abnormalities and for elevated leukocyte count.