Systemic inflammation reaction associated with 90-day mortality in patients with HBV related acute on chronic liver failure without infection

Abstract Background Acute on chronic liver failure (ACLF) is the final and the most fatal stage of acute decompensated cirrhosis which affects most organs and systems of the body. Systemic inflammation plays an important role in the pathogenesis of ACLF. Systemic inflammation reaction syndrome (SIRS) is a marker of ongoing inflammation. Therefore, we aim to evaluate the relationship of sterile SIRS with HBV related ACLF (HBV-ACLF) without infection. Methods Patients with HBV-ACLF without infection who were hospitalized in December 2016 to December 2018 were retrospectively analyzed. All patients were followed up until 90 days and monitored for the presence and development of SIRS. Risk factors associated with 90-day mortality and SIRS development were studied. Results Of 151 HBV-ACLF patients without infection, 37 patients (24.5%) presented and developed SIRS within the 7 days after admission. 23 and 40 patients died in HBVACLF patients with and without SIRS (62.2% vs 35.1%, p=0.004) during 90 days follow up. On univariate analysis, older age, higher TBIL, INR, presence of SIRS, MELD score, presence of complications and organ failures associated with 90-day mortality. The presence of SIRS was an independent risk factor for 90-day mortality in multivariate analyses. In the individual component of SIRS, patients who fulfilled the criterion of heart rate was the most (56, 37.09%). Patients who fulfilled the criterion of heart rate or temperature had lower 90-day survival rate than those who did not (46.4% vs 65.3%, p=0.020;16.7% vs 60.0%, p=0.020). Of 114 patients without SIRS at admission, 21 patients developed SIRS within 7 days after admission. WBC and TBIL levels were risk factors associated with SIRS development. Patients with SIRS developed after admission still showed lower 90-day survival rate than non-SIRS group (23.8% vs 64.9%, p < 0.0001). Conclusions SIRS presented in HBV-ACLF patients even without infection that was closely associated with prognosis. HBV-ACLF patients with sterile SIRS had a high mortality than those without. Target the pathway of systemic inflammation reaction may be an effective way to treat patients with HBV-ACLF.