The systemic inflammatory response syndrome in acute liver failure
The systemic inflammatory response syndrome in acute liver failure
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DOI：
10.1053/jhep.2000.17687
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发表时间：
2000-10-01
期刊：
影响因子：
13.5
通讯作者：
Williams, R
中科院分区：
文献类型：
--
作者：
Rolando, N;Wade, J;Williams, R
急性肝衰竭（ALF）中感染常见的全身炎症反应综合征（SIRS）尚未得到研究。在这项研究中，在 11 年期间记录了 887 名 ALF 患者入院时和感染期间的 SIRS 成分。总体而言，504 名 (56.8%) 患者在患病期间表现出 SIRS，最多分别有 166 名、238 名和 100 名患者同时出现 1、2 和 3 种 SIRS 症状。在 353 名 (39.8%) 未感染的患者中，入院时出现 SIRS 与病情更严重、随后脑病恶化和死亡有关。受感染的患者更常出现 SIRS，而且程度更严重。 273 名细菌感染患者的 SIRS 严重程度与死亡率相关，在同时存在 0、1、2 和 3 个最大并发 SIRS 成分的患者中，SIRS 的严重程度分别为 16.7%、28.4%、41.2% 和 64.7%。与真菌感染、菌血症和细菌性胸部感染相关的 SIRS 与死亡率也存在类似的相关性。 59% 的严重脓毒症患者死亡，98% 的脓毒性休克患者死亡。研究发现进行性脑病与感染之间存在显着关联。患有进行性脑病的感染患者比其他感染患者表现出更多的 SIRS 成分。对于 SIRS 患者，感染和未感染患者表现出脑病恶化的比例相似。在 ALF 中，SIRS，无论是否由感染引起，似乎与脑病的进展有关，从而降低了移植的机会并导致较差的预后。
The systemic inflammatory response syndrome (SIRS) in acute liver failure (ALF), in which infection is common, has not been studied. In this study, SIRS components were recorded on admission and during episodes of infection, in 887 ALF patients admitted to a single center during an 11-year period. Overall, 504 (56.8%) patients manifested a SIRS during their illness, with a maximum of 1, 2, and 3 concurrent SIRS components in 166, 238, and 100 patients, respectively. In 353 (39.8%) patients who did not become infected, a SIRS on admission was associated with a more critical illness, subsequent worsening of encephalopathy, and death. infected patients more often developed a SIRS and one of greater magnitude. The magnitude of the SIRS in 273 patients with bacterial infection correlated with mortality, being 16.7%, 28.4%, 41.2%, and 64.7% in patients with 0, 1, 2, and 3 maximum concurrent SIRS components, respectively. Similar correlations with mortality were seen for SIRS associated with fungal infection, bacteremia, and bacterial chest infection. Fifty-nine percent of patients with severe sepsis died, as did 98% of those with septic shock. A significant association was found between progressive encephalopathy and infection. Infected patients with progressive encephalopathy manifested more SIRS components than other infected patients. For patients with a SIRS, the proportions of infected and noninfected patients manifesting worsening encephalopathy were similar. In ALF, the SIRS, whether or not precipitated by infection, appears to be implicated in the progression of encephalopathy, reducing the chances of transplantation and conferring a poorer prognosis.