The Diagnostic Efficacy And Short-term Prognostic Value Of 4 Kinds Of Scoring System For Patients With Cirrhosis Combined With Sepsis

Background & Aims:Compare Sepsis-1.0,Sepsis-3.0,rapid sequential organ failure score(qSOFA),and chronic liver failure-sequential organ failure(CLIF-SOFA)scoring system for the diagnosis of sepsis in patients with cirrhosis and predictive value for 28-day mortality in these patients.Methods: A retrospective analysis was conducted in a cohort of cirrhotic patients with infection who were admitted to the Liver Research Center of the First Affiliated Hospital of Fujian Medical University from January 2014 to December 2016.Sepsis-1.0(Infection+Systemic Inflammatory Response Syndrome(SIRS)score ? 2points),Sepsis-3.0(Infection + Fast Sequential Organ Failure Score(SOFA)score ?2points),qSOFA score ? 2 points and CLIF-SOFA score ? 2 were used for the diagnosis of sepsis.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive value of the four scoring systems for short-term prognosis in patients with cirrhosis combined with sepsis.Results: A total of 216 cases of liver cirrhosis combined with infection were finally included with 197 cases survived over 28 days and 19(8.8%)cases died with 28 days.HBV-related cirrhosis was the main cause of liver cirrhosis(145 cases,67.1%).The main source of infection was pulmonary infection(117 cases,54.2%).Among the 216 selected patients,122(56.5%),161(74.5%),175(81%),and 11(6.9%)were diagnosed as sepsis according to Sepsis-1.0,Sepsis-3.0,CLIF-SOFA and qSOFA criteria respectively.The mortality rates of patients who met Sepsis-3.0 and CLIF-SOFA diagnostic criteria were 11.8% and 10.9% respectively,and the mortality rate of the non-sepsis group was 0.According to Sepsis-1.0,the mortality rate of Sepsis was 13.9%(17/122),while the mortality rate in patients who were diagnosed with non-sepsis was 2.1%(2/94).The mortality rate of sepsis was highest in qSOFA group(6/11,54.5%),and the mortality rate of non-sepsis in this group was 6.3%(2/94).The ROC curve analysis for predictive value of 28 days mortality showed thatthe AUC of CLIF-SOFA was higher than SOFA(0.751[95%CI,0.680-0.813] vs.0.649[95%CI,0.570-0.722]).CLIF-SOFA score had the highest predictive efficiency with AUC of 0.751(P<0.001)and the optimal truncation value was 5 points,with thesensitivity of 78.95% and specificity of 60.90%.The AUC of SIRS was 0.527,and the AUC of qSOFA was 0.667,and P all >0.05.The PPV of qSOFA is 55.6% and NPV is 100%.Conclusions:1.The CLIF-SOFA score has the highest diagnostic value for sepsis,followed by Sepsis-3.0 and Sepsis-1.0,and qSOFA.2.CLIF-SOFA score and SOFA score can effectively predict short-term prognosis in patients with cirrhosis combined with sepsis.The CLIF-SOFA score has the highest predictive efficiency,and it is more suitable for patients with liver disease.While SIRS and qSOFA scoring system may lead to missed diagnosis in critically ill patients.