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. 2018 Apr 9:11:143-152.
doi: 10.2147/CEG.S140655. eCollection 2018.

Systemic inflammatory response syndrome and model for end-stage liver disease score accurately predict the in-hospital mortality of black African patients with decompensated cirrhosis at initial hospitalization: a retrospective cohort study

Alassan Kouamé Mahassadi  1 , Justine Laure Konang Nguieguia  1 , Henriette Ya Kissi  1 , Anthony Afum-Adjei Awuah  2 , Aboubacar Demba Bangoura  1 , Stanislas Adjeka Doffou  1 , Alain Koffi Attia  1
Affiliations

Systemic inflammatory response syndrome and model for end-stage liver disease score accurately predict the in-hospital mortality of black African patients with decompensated cirrhosis at initial hospitalization: a retrospective cohort study

Alassan Kouamé Mahassadi et al. Clin Exp Gastroenterol. .

Abstract

Background: Systemic inflammatory response syndrome (SIRS) and model for end-stage liver disease (MELD) predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis.

Aim: This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization.

Patients and methods: In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70.4% males). The role of Child-Pugh-Turcotte (CPT) score, MELD score, and SIRS on mortality was determined by the Kaplan-Meier method, and the prognosis factors were assessed with Cox regression model.

Results: At initial hospitalization, 74.2%, 20.1%, and 37.7% of the patients with cirrhosis showed the presence of ascites, hepatorenal syndrome, and esophageal varices, respectively. During the in-hospital follow-up, 40 (25.2%) patients died. The overall incidence of mortality was found to be 3.1 [95% confidence interval (CI): 2.2-4.1] per 100 person-days. Survival probabilities were found to be high in case of patients who were SIRS negative (log-rank test= 4.51, p=0.03) and in case of patients with MELD score ≤16 (log-rank test=7.26, p=0.01) compared to the patients who were SIRS positive and those with MELD score >16. Only SIRS (hazard ratio (HR)=3.02, [95% CI: 1.4-7.4], p=0.01) and MELD score >16 (HR=2.2, [95% CI: 1.1-4.3], p=0.02) were independent predictors of mortality in multivariate analysis except CPT, which was not relevant in our study. Patients with MELD score >16 experienced hepatorenal syndrome (p=0.002) and encephalopathy (p=0.001) more frequently than that of patients with MELD score ≤16. SIRS was not useful in predicting complications.

Conclusion: MELD score and SIRS can be used as tools for the prediction of mortality in black African patients with decompensated cirrhosis.

Keywords: Africa; MELD; SIRS; cirrhosis; mortality.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Survival plots of patients according to SIRS (A) and MELD score (B). MELD score was computed for 148 patients. Abbreviations: MELD, model for end-stage liver disease; SIRS, systemic inflammatory response syndrome.
Figure 2
Figure 2
AUROCs of MELD score, Child–Pugh, and the combination of SIRS and MELD score in parallel and sequential testing for the prediction of mortality. Notes: AUROCs were calculated with logistic regression in which MELD and Child–Pugh were used as continuous variables. MELD U SIRS: parallel testing. MELD ∩ SIRS: serial testing. MELD ∩ SIRS was not included in multiple comparisons involving MELD score, Child–Pugh–Turcotte, and MELD U SIRS as the sample size was not identical (n=67). MELD-Na was not included. Abbreviations: MELD, model for end-stage liver disease; SIRS, systemic inflammatory response syndrome; AUROCs, Area under receiver operating characteristic curves.
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References

    1. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–851. - PMC - PubMed
    1. Planas R, Montoliu S, Ballesté B, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol. 2006;4(11):1385–1394. - PubMed
    1. Tandon P, Garcia-Tsao G. Bacterial infection, sepsis and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28(1):26–42. - PubMed
    1. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis. A systematic review of 118 studies. J Hepatol. 2006;44(1):217–231. - PubMed
    1. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatol. 2000;31(4):864–871. - PubMed

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