Applicability of Sepsis‐3 criteria and quick Sequential Organ Failure Assessment in patients with cirrhosis hospitalised for bacterial infections

Abstract

Background & Aims An algorithm including Sepsis‐3 criteria and quick Sequential Organ Failure Assessment (qSOFA) was recently proposed to predict severity of infection in cirrhosis. However, its applicability among patients without a baseline SOFA available for Sepsis‐3 definition is unknown. We sought to investigate the applicability and prognostic value of qSOFA and Sepsis‐3 criteria in patients with cirrhosis hospitalised for bacterial infections, without pre‐hospitalisation SOFA. Methods In this cohort study, 164 patients were followed up to 30 days. Data collection, including the prognostic models, was performed at admission and at day‐3. Results All patients fulfilled Sepsis‐3 criteria (admission SOFA ≥ 2) and, therefore, admission Sepsis‐3 was not included in further analysis. Admission qSOFA was an independent predictor of survival (HR = 2.271, P = 0.015). For patients initially classified as high risk by qSOFA, Chronic Liver Failure ‐ Sequential Organ Failure Assessment (CLIF‐SOFA) was the only prognostic predictor. Among patients initially classified as low risk by qSOFA, the following parameters evaluated at day‐3 were independent predictors of survival: qSOFA, acute‐on‐chronic liver failure, and Child‐Pugh classification. Although not independently related to survival, Sepsis‐3 criteria at day‐3 was associated with lower 30‐day survival in Kaplan‐Meier analysis (66% vs 85%, P = 0.008). However, prognosis was better predicted by day‐3 qSOFA, with 30‐day Kaplan‐Meier survival probability of 88% when qSOFA < 2 and 24% among those with qSOFA ≥ 2. Conclusion Sepsis‐3 criteria evaluated at admission are very limited in infected patients with cirrhosis without baseline SOFA. qSOFA was independently related to survival and appears to be a valuable tool for determining severity of infection and to follow patients initially classified as low risk.

Update on diagnosis and management of sepsis in cirrhosis: Current advances

“…Patients fulfilling Sepsis-3 criteria had a higher incidence of ACLF, septic shock, and transfer to an intensive unit that those without. In a more recent study, Augustinho et al[ 61 ] showed that in patients with cirrhosis hospitalized for bacterial infections, admission qSOFA was an independent predictor of survival, and for those classified as high risk for death by qSOFA, only the CLIF-SOFA predicted prognosis independently, and Sepsis-3 criteria did not play a major role in predicting risk or stratifying patients. Lan et al[ 62 ] in a large retrospective cohort found that CLIF-SOFA and CLIF-organ failure scores were better tools that qSOFA, MELD, or qCLIF-SOFA in the evaluation of prognosis of critically ill patients with cirrhosis with suspected infections.…”

Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study

“…11 While current research mainly focuses on the application of SOFA scores in patients with sepsis, it is also useful in aluminum phosphide-poisoned patients 12 and patients with cirrhosis. 13 However, few studies have examined the predictive value of the SOFA score in prognosis of patients with severe AIS.…”

Systemic Inflammatory Response Syndrome in Patients Hospitalized for Acute Decompensation of Cirrhosis

“…As a result, infections are among the most relevant clinical problems in patients with cirrhosis. Bacterial infections are present at admission in about one-third of the patients [ 4 , 5 ] and are related to significant morbidity, mortality, and progression with acute-on-chronic liver failure (ACLF) [ 4 , 6 , 7 ]. Consequently, early identification of patients with cirrhosis at high risk of complications and mortality related to infections is decisive for an effective management.…”

“…For many years, systemic inflammatory response syndrome (SIRS) was used to define sepsis. Nevertheless, SIRS criterion was recognized to be limited as a prognostic tool in general population [ 8 ] and, particularly, among patients with cirrhosis [ 5 , 9 ]. Several factors commonly observed among cirrhotics may impair SIRS parameters, including tachypnea due to encephalopathy, hypersplenism-related leukopenia, or bradycardia induced by beta-blockers.…”

“…Several factors commonly observed among cirrhotics may impair SIRS parameters, including tachypnea due to encephalopathy, hypersplenism-related leukopenia, or bradycardia induced by beta-blockers. Recently, the Sepsis-3 criterion was proposed as new definitions of sepsis in general population and subsequently validated in patients with cirrhosis [ 5 , 10 , 11 ]. One of the most important limitations of these new criteria is that, in the context of a patient with cirrhosis recently admitted and without a baseline SOFA score available, Sepsis-3 criterion is of little value [ 5 ].…”