SNFGE SNFGE
 
Thématique :
- Foie (hors cancers)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Bertrand HANSLIK
Coup de coeur :
 
 
Gut
  2018/10  
 
  2018 Oct;67(10):1892-1899.  
  doi: 10.1136/gutjnl-2017-314324.  
 
  Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections.  
 
  Piano S, Bartoletti M, Tonon M, Baldassarre M, Chies G, Romano A, Viale P, Vettore E, Domenicali M, Stanco M, Pilutti C, Frigo AC, Brocca A, Bernardi M, Caraceni P, Angeli P  
  https://www.ncbi.nlm.nih.gov/pubmed/28860348  
 
 

Abstract
 

INTRODUCTION:

Patients with cirrhosis have a high risk of sepsis, which confers a poor prognosis. The systemic inflammatory response syndrome (SIRS) criteria have several limitations in cirrhosis. Recently, new criteria for sepsis (Sepsis-3) have been suggested in the general population (increase of Sequential Organ Failure Assessment (SOFA) ≥2 points from baseline). Outside the intensive care unit (ICU), the quick SOFA (qSOFA (at least two among alteration in mental status, systolic blood pressure ≤100 mm Hg or respiratory rate ≥22/min)) was suggested to screen for sepsis. These criteria have never been evaluated in patients with cirrhosis. The aim of the study was to assess the ability of Sepsis-3 criteria in predicting in-hospital mortality in patients with cirrhosis and bacterial/fungal infections.

METHODS:

259 consecutive patients with cirrhosis and bacterial/fungal infections were prospectively included. Demographic, laboratory and microbiological data were collected at diagnosis of infection. Baseline SOFA was assessed using preadmission data. Patients were followed up until death, liver transplantation or discharge. Findings were externally validated (197 patients).

RESULTS:

Sepsis-3 and qSOFA had significantly greater discrimination for in-hospital mortality (area under the receiver operating characteristic (AUROC)=0.784 and 0.732, respectively) than SIRS (AUROC=0.606) (p<0.01 for both). Similar results were observed in the validation cohort. Sepsis-3 (subdistribution HR (sHR)=5.47; p=0.006), qSOFA (sHR=1.99; p=0.020), Chronic Liver Failure Consortium Acute Decompensation score (sHR=1.05; p=0.001) and C reactive protein (sHR=1.01;p=0.034) were found to be independent predictors of in-hospital mortality. Patients with Sepsis-3 had higher incidence of acute-on-chronic liver failure, septic shock and transfer to ICU than those without Sepsis-3.

CONCLUSIONS:

Sepsis-3 criteria are more accurate than SIRS criteria in predicting the severity of infections in patients with cirrhosis. qSOFA is a useful bedside tool to assess risk for worse outcomes in these patients. Patients with Sepsis-3 and positive qSOFA deserve more intensive management and strict surveillance.

 
Question posée
 
Evaluer la pertinence du score pronostique Sepsis-3 (dérivé du SOFA) de mortalité par infection chez le patient cirrhotique.
 
Question posée
 
Ce score prédit la sévérité des infections chez le cirrhotique (auroc : 0,78), et mieux que le SIRS.
 
Commentaires

Score simple, que l’on peut d’emblée utiliser en pratique clinique.

 
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