Sterile systemic inflammation reaction associated with 90-day mortality in patients with HBV-related acute-on-chronic liver failure

Eur J Gastroenterol Hepatol. 2025 May 1;37(5):644-651. doi: 10.1097/MEG.0000000000002937. Epub 2025 Feb 12.

Abstract

Background: Acute-on-chronic liver failure (ACLF) represents the terminal and most lethal phase of acute decompensated cirrhosis. Systemic inflammation plays a critical 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 hepatitis B virus (HBV)-related ACLF (HBV-ACLF).

Methods: HBV-ACLF patients with sterile SIRS who were hospitalized between December 2016 and December 2018 were retrospectively analyzed. All patients were followed up until 90 days. Risk factors associated with 90-day mortality and sterile SIRS development were assessed.

Results: Among 151 HBV-ACLF patients without infection, 37 patients (24.5%) presented with or developed sterile SIRS. During the 90-day follow-up, 23 of the 37 patients with sterile SIRS died (62.2%), compared to 40 patients without sterile SIRS (35.1%, P = 0.004). Univariate analysis showed that age, total bilirubin (TBIL), international normalized ratio, ammonia, presence of sterile SIRS, model for end-stage liver disease score, presence of complications, and organ failures were associated with 90-day mortality. In multivariate analyses, the presence of sterile SIRS was an independent risk factor for 90-day mortality. Among SIRS components, heart rate (HR) was the most frequently met criterion (56 patients, 37.09%). Patients who met the HR or temperature criterion 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).

Conclusion: The presence of sterile SIRS in HBV-ACLF patients was closely associated with prognosis.

Keywords: acute-on-chronic liver failure; hepatitis B; systemic inflammation reaction syndrome.

MeSH terms

  • Acute-On-Chronic Liver Failure* / diagnosis
  • Acute-On-Chronic Liver Failure* / mortality
  • Acute-On-Chronic Liver Failure* / virology
  • Adult
  • Aged
  • Female
  • Hepatitis B* / complications
  • Hepatitis B* / mortality
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Systemic Inflammatory Response Syndrome* / diagnosis
  • Systemic Inflammatory Response Syndrome* / mortality
  • Time Factors