The Sepsis-3 criteria accurately predict outcomes in patients with cirrhosis and bacterial infections, according to a recent study.
The prospective study included 259 consecutive hospitalized patients in Italy who had cirrhosis and bacterial or fungal infections. Researchers gathered demographic, laboratory, and microbiological data at diagnosis of infection, and when available, preadmission data was used to calculate a baseline Sequential Organ Failure Assessment (SOFA) score. The study's results were validated in a cohort of 197 patients and published online by Gut on Aug. 31.
Compared to systemic inflammatory response syndrome (SIRS) criteria, both Sepsis-3 criteria and the quick SOFA (qSOFA) tool had significantly better discrimination for in-hospital mortality (areas under the curve, 0.606, 0.784, and 0.732, respectively), with similar results in the validation cohort. In-hospital mortality was independently predicted by Sepsis-3 (subdistribution hazard ratio [sHR], 5.47), qSOFA (sHR, 1.99), the Chronic Liver Failure Consortium Acute Decompensation score (sHR, 1.05), and C-reactive protein level (sHR, 1.01). Patients who met the Sepsis-3 criteria also had higher incidence of acute-on-chronic liver failure, septic shock, and transfer to the ICU.
The SIRS criteria had already been known to have significant shortcomings when applied to patients with cirrhosis, the study authors said. This study showed that the Sepsis-3 criteria have better prognostic accuracy than SIRS. Sepsis-3 and qSOFA are still “far from being perfect,” the authors said, but they did identify a group of patients with higher short-term mortality risk. “Patients with Sepsis-3 and positive qSOFA deserve more intensive management and strict surveillance,” they wrote.
One particular challenge is applying the new criteria to patients with cirrhosis and no baseline SOFA score, the authors noted. To resolve this, they proposed a new algorithm for such patients. If a baseline SOFA score is not available, both Sepsis-3 and qSOFA should be calculated. If both are positive, then patients should be considered high risk. However, if only Sepsis-3 is positive, patients are in a gray zone, and the SOFA score should be monitored on an ongoing basis.